A risky business? Health and physical activity from the perspectives of urban Australian Indigenous young people

Being Aboriginal or Torres Strait Islander in contemporary Australia is often discursively constructed in health literature as equating with risks of many kinds. This article explores the ways in which a group of urban Australian Indigenous young people perceive, navigate and articulate the so-called ‘risks' pertaining to issues surrounding their health and physical activity. Eight girls and six boys aged 11–13 years were recruited from an urban school in a major Australian city. Each young person was interviewed up to eight times, using multi-modal tools, over two and a half years, to explore the ways in which they engaged with discourses about health, risk and physical activity. Data were analysed both thematically and through a process of critical discourse analysis. The young people in this study did not perceive themselves as ‘at-risk’ of ill-health despite the recognition of ‘unhealthy’ choices or a family history of chronic illness. They appeared to negotiate risk based on both their knowledge of public health messages and their trust in themselves and those around them. The young people's narratives offer an alternate view to the pathologised, statistical ‘stories’ often representing Indigenous Australians in scientific and popular literature and the media.     

‘Women are supposed to be the leaders’: intersections of gender,race and colonisation in HIV prevention with Indigenous young people

Focusing on gender, race and colonialism, this paper foregrounds the voices of Indigenous young people, their histories of oppression, their legacies of resistance and the continuing strengths rooted in Indigenous peoples, their cultures and their communities. Exploring the relationship between gender and colonialism, the paper speaks to the lived realities of young people from Indigenous communities across Canada. Over 85 young people participated in six different Indigenous community workshops to create artistic pieces that explored the connections between HIV, individual risk and structural inequalities. In the course of the research, Indigenous young people, and young Indigenous women in particular, talked about how gender intersects with race and colonisation to create experiences that are, at times, especially difficult for them. In this paper, young people discuss the ways in which colonialism has demeaned women's roles and degraded women's sexuality, and how continuing cultural erasure and assimilationist policies impact on their lives and on their bodies.     

Culture and healthy lifestyles: a qualitative exploration of the role of food and physical activity in three urban Australian Indigenous communities

Objective: 1) To explore the links between Indigenous Australian children's perspectives on culture, and healthy lifestyle behaviours. 2) To provide insight into how to approach the development of a health intervention targeting lifestyle behaviours in Australian Indigenous children. Methods: Seven semi‐structured focus groups sessions were conducted with Australian Indigenous children aged 5–12 years living on the South Coast of New South Wales. Audio‐recordings were transcribed and thematic analyses were conducted and related to principles of grounded theory. Results: Participants had connections to aspects of Australian Indigenous culture that were embedded in their everyday lives. Healthy lifestyle behaviours (such as healthy eating and physical activity) were found to be interconnected with Australian Indigenous culture and positive emotional wellbeing was identified as an important outcome of connecting Australian Indigenous children to cultural practices. Conclusion: Understanding the importance of culture and its role in healthy lifestyles is critical in the development of health interventions for Indigenous populations. Implication: Health interventions embedded with Australian Indigenous culture may have potential to improve physical and emotional health within Australian Indigenous communities. However, it is unlikely that a ‘one size fits all’ approach to health interventions can be taken.     

Learning from the past: young Indigenous people's accounts of blood-borne viral and sexually transmitted infections as resilience narratives

The Indigenous Resilience Project is an Australian community-based participatory research project using qualitative methods to explore young Aboriginal and Torres Strait Islander people's views of blood-borne viral and sexually transmitted infections (BBV/STI) affecting their communities. In this paper we present an analysis of narratives from young people who had a previous BBV/STI diagnosis to explore how they actively negotiate the experience of BBV/STI infection to construct a classic resilience narrative. We examine two overarching themes: first, the context of infection and diagnosis, including ignorance of STI/BBV prior to infection/diagnosis and, second, turning points and transformations in the form of insights, behaviours, roles and agency. Responding to critical writing on resilience theory, we argue that providing situated accounts of adversity from the perspectives of young Indigenous people prioritises their subjective understandings and challenges normative definitions of resilience.     

Practical strategies for working with indigenous people living in Queensland,Australia

Internationally, occupational therapists have recognized the need to provide culturally appropriate services for indigenous people. This study explored experiences, perspectives and practical strategies of occupational therapists working with Aboriginal and Torres Strait Islander people living in rural and remote areas of Queensland, Australia. Semi-structured interviews were conducted with eight occupational therapists who had at least 12 months' experience providing services to Aboriginal and Torres Strait Islander people in health, rehabilitation or education services. Key themes identified in the data focused on strategies for facilitating effective communication with individuals and families, and collaborating with other service providers. The role of Aboriginal Liaison Officers or Indigenous Health Workers was emphasized by participating therapists. Participants identified resources that they perceived as useful in their practice, such as cross-cultural training and access to indigenous health workers. Other resources suggested for further development included information about learning styles of indigenous people and information about cultural variations between specific Aboriginal and Torres Strait Islander communities. The small number of participants limits generalizability of the findings. However, therapists can decide on the relevance of strategies to their own workplaces. Suggestions for further research focused on improving occupational therapy services for indigenous people in Australia. These include an investigation of therapy goals with indigenous people, and interviews with indigenous Australians and indigenous health workers about their experiences and perceptions of occupational therapy.     

‘We don't tell people what to do’: ethical practice and Indigenous health promotion

Health promotion aspires to work in empowering, participatory ways, with the goal of supporting people to increase control over their health. However, buried in this goal is an ethical tension: while increasing people's autonomy, health promotion also imposes a particular, health promotion‐sanctioned version of what is good. This tension positions practitioners precariously, where the ethos of empowerment risks increasing health promotion's paternalistic control over people, rather than people's control over their own health. Herein we argue that this ethical tension is amplified in Indigenous Australia, where colonial processes of control over Indigenous lands, lives and cultures are indistinguishable from contemporary health promotion ‘interventions’. Moreover, the potential stigmatisation produced in any paternalistic acts ‘done for their own good’ cannot be assumed to have evaporated within the self‐proclaimed ‘empowering’ narratives of health promotion. This issue's guest editor's call for health promotion to engage ‘with politics and with philosophical ideas about the state and the citizen’ is particularly relevant in an Indigenous Australian context. Indigenous Australians continue to experience health promotion as a moral project of control through intervention, which contradicts health promotion's central goal of empowerment. Therefore, Indigenous health promotion is an invaluable site for discussion and analysis of health promotion's broader ethical tensions. Given the persistent and alarming Indigenous health inequalities, this paper calls for systematic ethical reflection in order to redress health promotion's general failure to reduce health inequalities experienced by Indigenous Australians.     

Relationships: the key to effective occupational therapy practice with urban Australian Indigenous children

The aim of this exploratory study was to investigate what constitutes a socially and culturally appropriate occupational therapy service for urban Indigenous Australian families in Brisbane, Queensland. A qualitative methodology was used with data collected in two distinct parts. Part 1 comprised interviews and focus groups with 25 stakeholders in a newly established occupational therapy service for Indigenous children. Part 2 consisted of semi-structured questionnaires completed by 50 occupational therapists in Queensland. Results revealed guidelines for developing culturally relevant practice around 5 main themes. These were the need to: 1. develop effective relationships, 2. develop particular personal qualities, 3. understand the background of both the client and the therapist, 4. both gain and give knowledge, and 5. address logistical issues of service delivery. This study was limited to an evaluation of one service and included only teachers, parents and health service personnel. These practice guidelines could be applied to other settings with other Indigenous children, and their effectiveness evaluated from the perspectives of Indigenous children.     

Ambivalent helpers and unhealthy choices: public health practitioners' narratives of Indigenous ill-health

Public health practitioners in Australian indigenous health work in a complex political environment. Public health training is limited in providing them with conceptual tools needed to unpack the postcolonial nexus of 'fourth-world' health. A workshop was designed by the authors to facilitate critical reflection on how the concepts of race and culture are used in constructions of indigenous ill-health. It was attended by researchers, students, clinicians and bureaucrats working in public health in northern Australia. A thematic analysis of the workshop minutes provided insight into public health practitioners' narratives of Indigenous ill-health. The major themes that emerged included tension between structure and agency and between sameness and difference, and ambivalence surrounding the 'helper' identity of public health practitioners. We suggest that these narratives can be understood as attempts to maintain the moral integrity of both Indigenous people and practitioners. This task is necessitated by the specter of cultural relativism intrinsic to contemporary liberal discourses of multiculturalism that attempt to reconcile the universal rights of the citizen with the special rights of minority groups. We argue that the concepts of self-determination and neocolonialism mark the spaces where universal and particular discourses overlap and clash. Practitioners who seek to escape neocolonialism must inhabit only the discursive space of public health congruent with self-determination, leaving them in a bind common to many postcolonial situations. They must relieve the ill-health of indigenous people without acting upon them; change them without declaring that change is required.     

Beyond good practice: Issues in working with people with intellectual disability and high support needs

Many more people with an intellectual disability now live in the community as a result of de-institutionalization. Occupational therapy is one service that assists people with intellectual disabilities to participate as fully as possible in their local communities. Despite the potential benefits of occupational therapy, there is little written about the types of interventions used and the effectiveness of their outcomes with people with intellectual disabilities. The present interview study about current occupational therapy practice with people with intellectual disabilities and high support needs was conducted with experienced Australian clinicians. Positive outcomes for clients with high support needs were achieved in two ways: (i) by what therapists do; and (ii) by the features of the therapy relationship. In addition, interventions that indirectly empowered clients and changed others' perceptions were seen to have the most positive effect. The findings are discussed with regard to current occupational therapy literature and implications for occupational practice and education are presented.     

Yarning quiet ways: Aboriginal carers’ views on talking to youth about sexuality and relationships

Issue addressed

Research suggests that young Indigenous people want carers to take a more active role in discussions about sexual health. The aim of this study was to ascertain carers’ perspectives of: the importance of providing young people with information about sex and sexual health; what they want young people to know about sex and sexual health; and facilitators and barriers to discussing sex and sexual health with youth.

Methods

Thirteen focus groups and three interviews were conducted with 81 carers in four rural and urban regions of Western Australia. Data were coded using a thematic approach, analysed using inductive Framework Analysis, and interpreted using the Aboriginal Family Wellbeing Model of Empowerment.

Results

Many participants recognised the need for talking with young people about sex, and said they drew upon resources such as books, pamphlets and television and used humour to impart lessons. However, a large proportion of participants reported difficulties in educating youth about sex. Participants noted that colonisation had disrupted traditional structures for educating young people, and that sex was a challenging topic. The forced removal of children had interfered with Indigenous family structures and deprived some participants of the opportunity to acquire knowledge and skills from their own parents.

Conclusions

Our findings emphasise the potential role of culture and empowerment in further improving outcomes related to relationships and sexual health. There is a need for more research into models of culturally‐empowering, family‐centred strategies for improving the sexual literacy of Indigenous youth.     

Great expectations: An analysis of researchers' and policy makers' perceptions of the potential value of the Australian indigenous burden of disease study for policy

The “Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples” was commissioned by the Australian government as part of the Australian Burden of Disease study. This paper explores the extent to which key actors in the research and policy communities expected the Indigenous Burden of Disease study's findings to inform, influence, or drive federal decisions concerning Indigenous health in Australia. This qualitative research undertook interviews with 13 key informants with significant involvement in the Indigenous Burden of Disease study: six researchers, five policy makers, and two knowledge brokers. Interviews were recorded, transcribed, and analyzed, and the findings were triangulated with a review of the literature. Policy makers and researchers anticipated that the Indigenous Burden of Disease study would improve the available information for policy deliberations about Indigenous health. Beyond that, their expectations about its policy influence differed substantially, with researchers more confident of the study's capacity to guide health priorities, and policy makers situating findings in the context of other critical inputs. Expectations of policy influence are shaped by the disciplinary perspectives of actors, and their relationship to policy outcomes and cannot be examined without also considering the policy, political, and financing context of the study being analyzed.     

Young people’s accounts of smoking,exercising, eating and drinking alcohol: being cool or being unhealthy?

This paper reports the findings of a study that explores how young people talk about smoking, eating, drinking alcohol and exercise in the context of their everyday lives. The study was motivated by recognizing the difficulties, within the field of health promotion, in recording the ‘everyday’ character of smoking, eating, drinking alcohol and exercise. The classification of these four behaviours as health-related overlooks their ‘everyday’ cultural meanings. Theories of consumer culture as an interpretive approach to contemporary life are found to represent alternative ways of understanding young people’s ‘health’ behaviours. Using information gathered from open-ended interviews with a sample of young people in Cyprus, a variety of processes are delineated in order to reveal the multidimensional phenomenon of people’s private accounts of ‘health’ behaviours. The findings reported here show how young people invest meanings in ‘health’ choices, which are closely related to the everyday contexts of consumption. What young people consume, and their representations of what they consume, are not only about health consciousness, but also about self-image, socialization and an active stylization of life. This is not to suggest that health consciousness is irrelevant to young people’s choices but such choices receive other meanings within consumer culture.     

Closing the gap between rhetoric and practice in strengths‐based approaches to Indigenous public health: a qualitative study

Objective : To understand strengths‐based practice as articulated by urban Indigenous community workers and to consider its application for public health approaches to Australian Indigenous health advancement. Methods : Semi‐structured interviews with community workers from an urban Indigenous community. Interviews were video and audio recorded and transcribed verbatim. Data were analysed using thematic analysis, using an Indigenist research framework. Results : For our participants (11 Indigenous and one non‐Indigenous), a strengths‐based approach was fundamental to their practice. This approach reconfigured the usual relationship of client and service provider to fellow community member. They understood the strength of Indigeneity that empowers individuals and communities. They were not blinkered to the challenges in the community but resisted defining themselves, their community or their community practice by these deficits. Conclusions : Our participants had a sophisticated experiential understanding that a strengths‐based practice is not simply a ‘culturally acceptable’ way for non‐Indigenous peoples to work for Indigenous peoples, but rather it is the only way of working with Indigenous people. Implications for public health : Strengths‐based practice requires a reconfiguring of relationships of power, of attending to structure over stereotypes, and privileging Indigenous ways of knowing, being and doing. This reconfiguration is an ethical prerequisite for an approach that is genuinely strengths‐based.     

Cultural safety — what does it mean for our work practice?

Culturally safe service delivery is critical in enhancing personal empowerment and, as a result, should promote more effective and meaningful pathways to self determination for Indigenous people. Little has been said about encouraging people from Indigenous groups into the health and education discipline(s) to help provide a safe environment which includes cultural safety. This is a phrase originally coined by Maori nurses which means that there is no assault on a person's identity. The people most able or equipped to provide a culturally safe atmosphere are people from the same culture. We need to move on from the 'short term, cost effective, quick fix' approach to Indigenous issues, driven by economic imperatives, the clamouring of industry and conservative, hegemonic practices. To genuinely address the challenges of Indigenous health and education, the issue of cultural safety cannot be avoided. Critical reflection on experiential knowledge and defining or framing a debate on cultural safety is essential. This paper briefly examines some considerations for work practice.     

The facilitators and barriers of physical activity among Aboriginal and Torres Strait Islander regional sport participants

Background : Disparities in health perspectives between Indigenous and non‐Indigenous populations are major concerns in many of the world's well‐developed nations. Indigenous populations are largely less healthy, more prone to chronic diseases, and have an earlier overall mortality than non‐Indigenous populations. Low levels of physical activity (PA) contribute to the high levels of disease in Indigenous Australians. Method : Qualitative analysis of structured one‐on‐one interviews discussing PA in a regional setting. Participants were 12 Indigenous Australian adults, and 12 non‐Indigenous Australian adults matched on age, sex, and basketball division. Results : Most participants reported engaging in regular exercise; however, the Indigenous group reported more barriers to PA. These factors included cost, time management and environmental constraints. The physical facilitators identified by our Indigenous sample included social support, intrinsic motivation and role modelling. Conclusion : Findings describe individual and external factors that promote or constraint PA as reported by Indigenous Australian adults. Results indicate that Indigenous people face specific barriers to PA when compared to a non‐Indigenous sample. Implications for public health: This study is the first to compare the perspective of Indigenous Australians to a matched group of non‐Indigenous Australians and provides useful knowledge to develop public health programs based on culturally sensitive data.     

Analysing ‘cultural safety’ in mental health policy reform: lessons from British Columbia,Canada

In response to the mental health disparities experienced by Aboriginal peoples, and related inequities regarding the accessibility to appropriate mental health care, there has been a shift in health policy to endorse ‘By Indigenous for Indigenous’ health care delivery models. In Canada, this has resulted in the creation of new mechanisms for Aboriginal participation in health care planning by health authorities with the goal of fostering culturally safe mental health and addictions care. Yet, there is a growing concern about the effects of neo-liberal cost concerns in health policy on the effective implementation of such progressive reform ideas. Drawing on a critical policy review and ethnographic interviews with four community-based Aboriginal organisations and one health authority, this article uses ‘cultural safety’ as a critical lens to discuss emerging tensions within the context of regional Aboriginal mental health care reform in British Columbia. The findings of this study draw attention to the intersecting ways that dominant socio-historical and political ideologies undermine cultural safety in decision-making and funding practices, thereby creating situations of cultural risk for both Aboriginal people working within the area of Aboriginal mental health and by extension for Aboriginal people who are seeking mental health and addictions care. The insights gained from this research contribute to the ongoing dialogue regarding how to foster culturally safe mental health policy and practice, and for action in the political realm.     

Powerful practices: The legacy of Margaret Mort

History is our present in the making. An appreciation of occupational therapy's origins, and of key people who contributed to its development, are important to understanding the current place of our profession in health care. This paper sketches the story of Margaret Mort, an historically significant Australian occupational therapist, from her early years as a wartime therapist to her later years as a pioneer in geriatric rehabilitation. Her work exemplifies principles which underpin contemporary occupational therapy practice and which this article chronicles for the edification of those curious about our profession's rich history.     

Indigenous health: a special moral imperative

The provision of health services to Indigenous people is not perceived by many Australians to be a moral issue. Indigenous health, however, is not only a moral issue, it is a moral issue that deserves special consideration. In many sectors of society, the correct moral path is unclear, but the circumstances of Indigenous health warrant special consideration which policy makers and health care administrators are uniquely placed to render. The settling of Australia was at the expense of Indigenous flourishing. There is little doubt that many of the current poor health outcomes qf Indigenous Australians result from their past impoverishment. We argue that each member of Australian society has inherited a collective moral responsibility, along with the social assets accrued at the expense of Indigenous Australians, irrespective of their personal complicity. Government, as representatives of the people, has a responsibility to repay some of this society's accrued moral debt through the allocation of resources independent of issues of equity.     

A case against generalisation of mental health occupational therapy in Australia

Background/aim: In 2009, the World Federation of Occupational Therapists International Advisory Group on Mental Health conducted a global survey that yielded data on mental health occupational therapy practice. The Australian dataset reflected aspects of the current situation of the Australian mental health occupational therapy workforce. Of particular interest were resource availability, workforce recruitment and retention, and perception of the future of mental health occupational therapy. Methodology: Using a cross‐sectional survey design, quantitative and qualitative data were gathered electronically over a one‐month period. Manual analysis indicated themes common to mental health occupational therapists across a framework of professional areas. Results: Findings suggested that role blurring negatively affected workforce retention. Workforce recruitment and retention were complicated by resource shortages. Some Federal Government initiatives were perceived as only partially beneficial to the profession. Conclusions: Survey respondents believed that mental health occupational therapy was a potential growth area particularly where occupational therapy specific skills were retained.     

Adolescent and young adult substance use in Australian Indigenous communities: a systematic review of demand control program outcomes

Objective: Identifying preventative approaches to substance use in Indigenous communities is the foundation for developing evidence‐based responses. This study reports the findings of a systematic review of the published literature evaluating the impact of substance use programs on Australian Indigenous youth. Methods: Evidence about the impact of substance use programs for Indigenous young people was identified from a systematic review of the literature conducted according to the Preferred Reporting Items for Systematic reviews and Meta‐Analyses guidelines. Results: Only four original studies that met the inclusion criteria were identified, although a further 19 papers that described characteristics of programs that may be associated with improved outcomes were reviewed. Conclusions: Evidence relevant to the outcomes of demand control programs that target Australian Indigenous youth substance use is both weak and inconsistent. There is a need to support the type of evaluation activity required to better understand program effectiveness and build the Indigenous knowledge base. Implications for public health: These findings are discussed in relation to the development of evidence‐based practice and the type of knowledge that is likely to be of most use to those seeking to address problems associated with youth substance use.