Family Violence and the Need for Prevention Research in First Nations, Inuit, and Métis Communities

Existing sources produce widely varying estimates of family violence in First Nations, Inuit, and Métis communities; taken together, they imply a convincing if poorly quantified higher risk of family violence in Aboriginal communities, with the greater burden borne by women. With the accelerating HIV epidemic in some Aboriginal communities, prevention of domestic violence takes on even greater urgency. Five planks in a prevention research platform include: training emerging researchers from all Aboriginal groups to promote culturally specific research; systematic review of unpublished and published knowledge of interventions that reduce domestic violence; intervention theory development specific to each community; attention to the particular ethical issues; and methods development focused on interventions.     

A phase II clinical trial of a dental health education program delivered by aboriginal health workers to prevent early childhood caries

ABSTRACT: BACKGROUND: Early Childhood Caries (ECC) is a widespread problem in Australian Aboriginal communities causing severe pain and sepsis. In addition dental services are difficult to access for many Aboriginal children and trying to obtain care can be stressful for the parents. The control of dental caries has been identified as a key indictor in the reduction of Indigenous disadvantage. Thus, there is a need for new approaches to prevent ECC, which reflect the cultural norms of Aboriginal communities. METHODS: This is a Phase II single arm trial designed to gather information on the effectiveness of a dental health education program for Aboriginal children aged 6 months, followed over 2 years. The program will deliver advice from Aboriginal Health Workers on tooth brushing, diet and the use of fluoride toothpaste to Aboriginal families. Six waves of data collection will be conducted to enable estimates of change in parental knowledge and their views on the acceptability of the program. The Aboriginal Health Workers will also be interviewed to record their views on the acceptability and program feasibility. Clinical data on the child participants will be recorded when they are 30 months old and compared with a reference population of similar children when the study began. Latent variable modeling will be used to interpret the intervention effects on disease outcome. DISCUSSION: The research project will identify barriers to the implementation of a family centered Aboriginal oral health strategy, as well as the development of evidence to assist in the planning of a Phase III cluster randomized study.Trial registrationACTRN12612000712808.     

Understanding the Role of Culture in Domestic Violence: The Ahimsa Project for Safe Families

Domestic violence affects women across all racial, national, social, and economic groups. In particular, immigrant and refugee families are at risk for domestic violence because of their migration history and differences in cultural values and norms. The Ahimsa for Safe Families Project is an innovative collaborative project that addresses domestic violence in immigrant and refugee communities in San Diego. The project is designed to increase awareness of domestic violence among Latino, Somali, and Vietnamese communities and to develop and implement culturally specific programs aimed at each community. Here the authors describe the Project's needs assessment and communitydialogues that guided the development of specific interventions; present the lessons learned; and describe replicable, culturally specific prevention strategies utilized by the Project.     

Suicide prevention in Aboriginal communities: application of community gatekeeper training

OBJECTIVE: Concern over the high rate of suicide among Aboriginal people on the south coast of NSW led to the development of a project aimed at preventing youth suicide in the Aboriginal communities of the Shoalhaven. This paper describes the development, implementation and evaluation of the project. METHOD: Following extensive consultation with the Aboriginal community, a range of culturally appropriate interventions were developed. The main focus was a series of community gatekeeper training workshops, which aimed to increase the potential of members of the Aboriginal community to identify and support people at risk of suicide and to facilitate their access to helping services. RESULTS: Evaluation of the workshops demonstrated an increase in participants' knowledge about suicide, greater confidence in identification of people who are suicidal, and high levels of intentions to provide help. Attitudes, subjective norms and barriers predicted intentions to help. CONCLUSIONS: The project indicated community members could be successfully trained in the recognition of individuals at risk of suicidal behaviour. Gatekeepers' attitudes and perceived barriers to helping predicted intentions to help those in need. There is a need for longer-term follow-up to assess the extent to which new knowledge and skills are used in practice. IMPLICATIONS: Suicide awareness and skills training have been demonstrated to be an effective early intervention strategy. Gatekeeper training empowers Aboriginal communities and is generally accepted. There is demand for such programs outside the Shoalhaven. The project has a methodological framework that can be easily adapted by other communities.     

Identifying the prevalence and correlates of STDs among women residing in rural domestic violence shelters

The present study uses a cross-sectional study design to assess the prevalence and abuse-related correlates of STDs among women (n = 203) residing in rural and nonurban domestic violence shelters, a venue in which health care providers could intervene by providing STD prevention counseling, diagnosis and treatment. To our knowledge, this is the first study to examine the prevalence and correlates of self-reported STDs among women residing in domestic violence shelters. In this sample, 99% of women reported being physically abused in the prior 2 months, 55% reported being sexually abused and 43% reported being raped. Further, 33% of women reported acquiring an STD during their abusive relationship, 13.3% reported acquiring multiple STDs and 9.2% reported acquiring an STD in the 2 months prior to entering the shelter. In this sample having a history of rape, having an unfaithful partner and fear negotiating condom use were all associated with having an STD history. Coordinating STD services with domestic violence shelters could reach a high-risk population that is not traditionally targeted by STD programs, could increase early detection of STDs, may increase access to and improve the quality of STD-related care, particularly among rural populations, and could be cost-effective.     

The Voices of Black and White Rural Battered Women in Domestic Violence Shelters*

Abstract: Very little research has examined the experiences of Black and White rural battered women. In this exploratory study of 88 participants, 30 rural battered women who sought assistance from domestic violence shelters in southwest Virginia were interviewed. Black and White rural women's experiences in the shelters, helpseeking, and perceived social support during and after their stay in the shelter were compared. Future research directions and suggestions to improve services are presented.     

Das S.I.G.N.A.L.-Interventionsprogramm gegen Gewalt an Frauen

Domestic violence has profound effects on the health of women. According to the World Health Organization, violence is a significant risk factor for morbidity and mortality in women. If violence is not taken into account as a cause of health problems, there is a high risk of inappropriate health care. More attention to the issue of domestic violence in medical history, diagnosis and therapy is the objective of the "S.I.G.N.A.L. Intervention Project to Combat Violence Against Women". The "S.I.G.N.A.L. Project" is the first intervention project against violence in a medical setting in Germany. It was started in 1999 in the emergency room of Benjamin Franklin University Hospital (Charite Campus Benjamin Franklin). The goal of the project is to initiate prevention and intervention for violence against women by providing the abused women with appropriate support and treatment. The program is based on the intervention objectives: ask about abuse, assess for danger, inform and refer victims to counselling programs and women's shelters, and document injuries and health problems for use in legal proceedings.     

Life Story Board: A Tool in the Prevention of Domestic Violence

The high rate of domestic violence in Aboriginal communities points to the need to explore new ways of understanding how this violence occurs in its context and to seek new and creative ways of preventing the perpetuation of this vicious cycle. The Life Story Board (LSB) is a game board with sets of cards, markers, and a notation system with which to construct a visual representation of someone's life experience at personal, family, and community levels. Initially invented as an interview tool in an expressive art program for war-affected children, the LSB has broader potential for use by those working with youth, adults, and families in a variety of contexts, and as a tool for program evaluation and applied research. This article describes LSB methods and how they may apply in the context of Canadian First Nations, Inuit, and Métis community efforts to respond to, understand, and prevent domestic violence.     

Low health-related quality of life among abused women

In a cross-sectional study, we sent a self-administered questionnaire to all the women’s shelters in Norway to describe health-related quality of life among women who had experienced violence from an intimate partner. Every woman who could understand Norwegian and was staying at a women’s shelter in Norway for more than 1 week from October 2002 to May 2003 was asked to participate. We described violence by intimate partners by using the Severity of Violence against Women Scale and the Psychological Maltreatment of Women Index. We used the SF-36 Health Survey to measure health-related quality of life. These women experienced a multitude of threats and actual physical and psychological violence during their partnership. Their health-related quality of life was low and significantly (p<0.001) below the norm for the female population of Norway in all dimensions. The SF-36 mental health dimension was 2.5 standard deviations below the norm. Women at women’s shelters in Norway who had experienced domestic violence had very low and clinically significantly reduced health-related quality of life scores. Health care workers must give priority to developing intervention plans for victims of violence from intimate partners.     

Reduction of Family Violence in Aboriginal Communities: A Systematic Review of Interventions and Approaches

Many efforts to reduce family violence are documented in the published literature. We conducted a systematic review of interventions intended to prevent family violence in Aboriginal communities. We retrieved studies published up to October 2009; 506 papers included one systematic review, two randomized controlled trials, and fourteen nonrandomized studies or reviews. Two reviews discussed interventions relevant to primary prevention (reducing the risk factors for family violence), including parenting, role modelling, and active participation. More studies addressed secondary prevention (where risk factors exist, reducing outbreaks of violence) such as restriction on the trading hours for take away alcohol and home visiting programs for high risk families. Examples of tertiary prevention (preventing recurrence) include traditional healing circles and group counselling. Most studies contributed a low level of evidence.     

Assessment of applicability and transferability of evidence-based antenatal interventions to the Australian indigenous setting

There is a need for public health interventions to be based on the best available evidence. Unfortunately, well-conducted studies from settings similar to that in which an intervention is to be implemented are often not available. Therefore, health practitioners are forced to make judgements about proven effective interventions in one setting and their suitability to make a difference in their own setting. The framework of Wang et al. has been proposed to help with this process. This paper provides a case study on the application of the framework to a decision-making process regarding antenatal care in Aboriginal and Torres Strait Islander communities in Queensland. This method involved undertaking a systematic search of the current available evidence, then conducting a second literature search to determine factors that may affect the applicability and transferability of these interventions into these communities. Finally, in consideration of these factors, clinical judgement decisions on the applicability and transferability of these interventions were made. This method identified several interventions or strategies for which there was evidence of improving antenatal care or outcomes. By using the framework, we concluded that several of these effective interventions would be feasible in Aboriginal and Torres Strait Islander communities within Queensland.     

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.     

To disrupt and displace: placing domestic violence on the public health agenda

In 1996, in Geneva, the World Health Assembly declared the violence as a major and growing public health problem. Others have gone further in describing (sexual) violence against women as a weapon of terror. In the local community of Hamilton, Ontario Canada (population approximately 500,000), domestic violence represents 25% of the workload of the local police service. The literature has shown that violence in general, and domestic violence in particular, presents tremendous social and health impacts for individuals and communities. In this local community, however, an evaluation of a recently piloted cutting edge domestic violence response system highlights how difficult it is to place domestic violence on the policy and/or public health agendas. Qualitative interviews with 23 key stakeholders were undertaken to assess their views on the success of the program. While overall findings indicate that the success of this brief (11 month) pilot project was limited, important insights emerged around responding to the domestic violence issue, at the community level.     

Occupational Needs and Goals of Survivors of Domestic Violence

This study's purpose was to describe the occupational needs and goals of women residing in a domestic violence shelter and their self-perceived changes in satisfaction and occupational performance. Using a retrospective design, data from 68 occupational therapy evaluations from two domestic violence shelter settings were examined. Data were analyzed by coding problem areas and occupational goals and calculating frequencies for these variables. Where data were available, we also analyzed changes in pre- and postscores for self-perceived satisfaction and occupational performance (n = 25). The most common problem areas were leisure, education, work, child rearing, and health management. The most common goals were in the areas of education, work, health management, child rearing, and home management. Retrospective pre- and postchange scores in performance and satisfaction for 25 women were statistically significant. Findings provide direction for, and highlight the importance of occupational therapy services within domestic violence shelters as women regain their life skills.     

A socioecological framework to understand weight-related issues in Aboriginal children in Canada

Obesity prevention efforts in Aboriginal (First Nations, Métis, or Inuit) communities in Canada should focus predominantly on children given their demographic significance and the accelerated time course of occurrence of type 2 diabetes mellitus in the Aboriginal population. A socioecological model to address childhood obesity in Aboriginal populations would focus on the numerous environments at different times in childhood that influence weight status, including prenatal, sociocultural, family, and community environments. Importantly, for Aboriginal children, obesity interventions need to also be situated within the context of a history of colonization and inequities in the social determinants of health. This review therefore advocates for the inclusion of a historical perspective and a life-course approach to obesity prevention in Aboriginal children in addition to developing interventions around the socioecological framework. We emphasize that childhood obesity prevention efforts should focus on promoting maternal health behaviours before and during pregnancy, and on breastfeeding and good infant and child nutrition in the postpartum and early childhood development periods. Ameliorating food insecurity by focusing on improving the sociodemographic risk factors for it, such as increasing income and educational attainment, are essential. More research is required to understand and measure obesogenic Aboriginal environments, to examine how altering specific environments modifies the foods that children eat and the activities that they do, and to examine how restoring and rebuilding cultural continuity in Aboriginal communities modifies the many determinants of obesity. This research needs to be done with the full participation of Aboriginal communities as partners in the research.     

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.     

Healthy Aboriginal communities

Abstract: Improving the health of Aboriginal and Torres Strait Islander populations is the greatest challenge facing public health in Australia today. The gains in the health of the population overall have not been matched by gains among these communities. Much of the information about the health of Aboriginal and Torres Strait Islander communities and people is negative, and little information is available about what Aboriginal and Torres Strait Islander people themselves consider to be indicators of healthy people and healthy communities.
This paper identifies some successful programs and highlights the need for community ownership of decisions about goals, services and programs. By looking to ways that Aboriginal people view their health (and its determinants), and to the examples of successful action to date, it is possible to begin to develop a vision of healthy Aboriginal communities in which the relationship between body, land and spirit has been restored. The need, now, is to build the partnerships that will be necessary to turn the vision into reality.     

Aboriginal Community-Centered Injury Surveillance: A Community-Based Participatory Process Evaluation

While injuries are a leading health concern for Aboriginal populations, injury rates and types vary substantially across bands. The uniqueness of Aboriginal communities highlights the importance of collecting community-level injury surveillance data to assist with identifying local injury patterns, setting priorities for action and evaluating programs. Secwepemc First Nations communities in British Columbia, Canada, implemented the Injury Surveillance Project using the Aboriginal Community-Centered Injury Surveillance System. This paper presents findings from a community-based participatory process evaluation of the Injury Surveillance Project. Qualitative data collection methods were informed by OCAP (Ownership, Control, Access, and Possession) principles and included focus groups, interviews and document review. Results focused on lessons learned through the planning, implementation and management of the Injury Surveillance Project identifying lessons related to: project leadership and staff, training, project funding, initial project outcomes, and community readiness. Key findings included the central importance of a community-based and paced approach guided by OCAP principles, the key role of leadership and project champions, and the strongly collaborative relationships between the project communities. Findings may assist with successful implementation of community-based health surveillance in other settings and with other health issues and illustrate another path to self-determination for Aboriginal communities. The evaluation methods represent an example of a collaborative community-driven approach guided by OCAP principles necessary for work with Aboriginal communities.     

Participatory action research as a strategy for empowering Aboriginal health workers

Abstract: A participatory action research project was undertaken with Aboriginal health workerson the Anangu Pitjantjatjara Lands in South Australia. The study examined the factors that affect the empowerment of Aboriginal health workers within the context of an Aboriginal–controlled primary health care service. This project was different from previous research conducted with Aboriginal healdi workers in remote areas for two reasons. First, it enabled them to participate actively as co–researchers in the study, and second, it brought about action and change during the research process. The three main factors preventing Aboriginal health workers from attaining a key role within the health service are the standard of training they receive, their low literacy and numeracy levels, and their lack of participation in decision making within the health service. Each of these factors is interrelated and all affect the Aboriginal healdi workers' ability to have more control and responsibility within the health service.