Introduction by Croakey: Knowledge translation has been at the heart of the Lowitja Institute’s work since its inception, due to the transformative potential for research, practice, policy and community wellbeing.
The Lowitja Institute’s way of doing knowledge translation means community members and end users drive the research agenda, ensuring it is research that Aboriginal and Torres Strait Islander people want and need.
The coolamon in the feature image above, courtesy of Dr Tess Ryan, represents a long cultural history of innovation and intergenerational transfer of knowledge.
This is the first in a series of four articles sponsored by the Lowitja Institute, and edited by Associate Professor Megan Williams, showing the diversity of Aboriginal and Torres Strait Islander knowledges and excellence in knowledge translation.
Croakey Professional Services writes:
“We have always been researchers,” says Dr Mark Wenitong, one of the first Aboriginal people trained in western medicine in Australia and an experienced researcher and policy adviser.
“Our knowledge bank is based on research over a very, very long period of time; it’s experiential research that has meaning for the cultural, social and emotional wellbeing of our communities.”
It is this sustained and effective use of research over millennia that compels Aboriginal and Torres Strait Islander researchers today as leading practitioners of knowledge translation and research for impact.
In this role Indigenous researchers are also frequently compelled to redress the overwhelmingly negative experiences Aboriginal and Torres Strait Islander peoples have had with their knowledges often being ignored, dismissed or diminished by western science researchers and rigid research methodologies and funding processes.
“Much of today’s health research is still done on, rather than by or with Aboriginal and Torres Strait Islander individuals and communities, without valuing local cultural protocols and ways of knowing, being and doing,” says Dr Janine Mohamed, CEO of the Lowitja Institute and a Narrunga Kaurna woman from South Australia.
“Since day one of British colonisation, systems in society had been created which privilege non-Indigenous peoples and lock out Aboriginal and Torres Strait Islander peoples, including from research and the benefits of research.
“Historic truth-telling reminds us that medical experimentation and many other harms were carried out on Aboriginal and Torres Strait Islander peoples in the name of ‘research’.
“This meant research was embedded in a deficit discourse, where we were the ‘problem’, rather than researchers turning their gaze to historical practices that caused such ongoing harm – colonisation, genocide, assimilation, the forced removal of our children, the Stolen Generations, and more.”
It’s led to what Associate Professor Felecia Watkin Lui calls “the elephant in the room” – in an era of increased government funding for Indigenous health research there has been little improvement in Aboriginal and Torres Strait Islander health outcomes.
“We’ve called it out because researchers are continuing to do more and more research in Indigenous health and yet we are not seeing the impact in our communities,” says Associate Professor Watkin Lui, head of the Indigenous Teaching Program at James Cook University.
“We have to change the way we do research. Our people are dying earlier and we cannot waste time doing more of the same given the acute challenges we have.”
Lowitja Institute’s approach to knowledge translation for research impact therefore comes as a “breath of fresh air” as a way to bridge the gap and apply knowledge to meet the needs of Indigenous communities, according to Dr Wenitong, strategic adviser to Lowitja Institute.
Lowitja Institute’s definition of knowledge translation is a reciprocal process that combines Indigenous people’s experiential wisdom with academic research:
Knowledge translation is the complex series of interactions between knowledge holders, knowledge producers and knowledge users, with the goal of achieving research impact, which we define as positive and sustainable long-term benefit for Aboriginal and Torres Strait Islander peoples, beyond the realm of academia.”
This research process flips the mainstream paradigm, starting with community engagement and leadership to co-design and develop research priorities and questions, select methodologies, collect and analyse data, translate knowledges and measure research impact.
“Measuring research impact helps us determine if our investment and implementation of knowledge translation activities has been effective at any point along the research timeline and if we have been successful in connecting research to impacts beyond academia for the benefit and empowerment of Aboriginal and Torres Strait Islander peoples,” says Dr Mohamed.
The Lowitja Institute is the only Aboriginal and Torres Strait Islander community controlled research institute in Australia. It is also the only known Australian research institute that funds knowledge translation from the beginning of the research process and incorporates the research principles of benefit, leadership, engagement, capacity building and measurement into planning.
What is the change you want to see?
Associate Professor Felecia Watkin Lui and her colleagues in the Torres Strait Researchers’ Community of Practice studied knowledge translation frameworks internationally and in Australia and identified more than 150 models for a scoping review.
Almost all of these models were ‘push’ systems primarily focused on the producers of knowledge who plan and implement approaches to push (disseminate) knowledge towards audiences who they believe need to receive it.
“Very few models were based on a ‘pull’ approach, where you ask the end user ‘what is the knowledge you need, what are your priorities, what is the change you want to see?’” says Associate Professor Watkin Lui.
Pull approaches involve the knowledge users who plan and implement strategies to pull knowledge from sources they identify as producing knowledge that is useful to their decision-making.
“The Lowitja Institute approach starts with the stakeholders to identify priorities and needs. At this stage we’re not even talking about projects, but we use community engagement to determine what change is required and then develop methodology and indicators to measure how we will translate this knowledge. Knowledge translation in many other models is often thought about at the end, if it’s thought about at all.”
Community engagement and knowledge translation for research output is rarely funded by government bodies such as the National Health and Medical Research Council (NHMRC) and the Australian Research Council. And it is all but impossible for community organisations to meet guidelines for research funding without a university or research institute leading the proposal.
The Lowitja Institute took a radical turn last year in its first funding round as a community-controlled organisation when it made health research funding available for community-based organisations such as Aboriginal-controlled health services, small businesses and non-government organisations. Universities and research institutes were not eligible for funding, except as partners with the community-based organisations.
“It’s really flipped the process and changed the power imbalance by giving control to community-based organisations,” says Associate Professor Watkin Lui.
Knowledge translation in practice
For Dr Mark Wenitong, a Kabi Kabi man from southern Queensland, knowledge translation has enhanced his research practice and better informed his clinical practice.
“It’s quite different from academia,” he says. “As a service provider in primary healthcare I’ve been frustrated by academic processes where a think-tank comes up with the research question without co-design by Indigenous communities. The research findings can then be irrelevant to service delivery, even though that was central to the research.”
A decade ago a small study looking at the high incidence of cannabis use in Cape York, found that 76 percent of users wanted to quit or reduce consumption. The main reasons for quitting were getting a job (26.9 percent), followed by being a role model for the family (16.4 percent), with concerns about physical and mental health and financial costs of the drug not registering above six percent, according to the Cape York Cannabis Project.
Dr Wenitong was then Aboriginal Public Health Medical Adviser at Apunipima Cape York Health Council and was able to translate the research findings into practice in other settings.
“We used the research in our men’s groups. We could say: ‘Do you guys want to be good role models for your family?’ And we knew it resonated because we had the research,” he says.
Dr Wenitong says the Aboriginal-developed and led Mayi Kuwayu National Study of Aboriginal and Torres Strait Islander Wellbeing is “so translatable into practice” and is now “a cross-cutting piece of policy” in the National Aboriginal and Torres Strait Islander Health Plan.
“It’s a much more grounded process when you have Aboriginal sovereignty about how the research is done, why it’s done, where it’s done and what the implications are, all the way through the process,” says Dr Wenitong.
Mayi Kuwayu, a ground breaking longitudinal study led by Wongaibon (Ngiyampaa) epidemiologist Associate Professor Ray Lovett, is measuring for the first time how Indigenous people’s wellbeing and health is linked to factors like connection to Country, cultural practices, spirituality and language. It aims to provide an evidence base for the creation of better policies and programs.
“Lowitja Institute is very proud to be one of the organisations that helped seed the idea of the Mayi Kuwayu study,” says Dr Mohamed.
She said mainstream funding bodies didn’t really understand the concept of the research but Aboriginal and Torres Strait Islander peoples knew “that people who live on Country, and are strong in culture, will usually have better health outcomes”.
“Lowitja Institute backed Ray’s research and he was later able to access NHMRC funding. About a quarter of our research grants go on to win bigger grants but we’re often the starting point for important research projects,” says Dr Mohamed.
Last year a Deloittes Access Economics Review of the Lowitja Institute found that a quarter of the 41 research projects supported between 2014 and 2019 received further grants from the NHMRC and the Australia Research Council (ARC).
More than 10,000 Aboriginal and Torres Strait Islander people have so far participated in Mayi Kuwayu. Over time the study aims to provide insights into how culture contributes to wellbeing and how oppression impedes health and wellbeing.
Creative strategies and cultural storytelling
Indigenous knowledges can be translated in many ways and are increasingly drawing on creative strategies using cultural metaphors, 21st century technologies like games-based problem-solving, and age-old ways of yarning in communities.
Knowledge translation can include changes to policy and clinical practice guidelines, information packages and fact sheets, video, storytelling, dance and performance.
Associate Professor Felecia Watkin Lui, whose giz or ancestral roots are from Erub (father) and Mabuiag Islands (mother), is a member of the first known Torres Strait Islander researchers’ community of practice known as ‘Meriba buay – ngalpan wakaythoemamay’ (We come together to share our thinking).
The community of practice, funded by the Lowitja Institute, sought to translate and use both western sciences and research, and local experiential (personal, traditional and cultural) knowledges, so that Torres Strait Islander people can develop their own solutions to the complex environmental and social problems in their communities.
Recognising the power of performance art in their communities, the researchers launched their first knowledge translation event about climate change at the 2018 Cairns Indigenous Art Fair, a high-profile event attended by politicians, Torres Strait Island community leaders and members.
The 15-minute multimedia performance piece titled ‘Woer Wayepa – The Water is Rising’ featured a time-travelling Elder in 2050. A tidal surge had sunk the last remaining island, culture was “clinging to a life buoy” and seagulls roamed the skies forever because there was nowhere to land.
“The performance used cultural metaphors, traditional language and visual storytelling in ways that are familiar to us, in addition to graphs of rising sea levels,” says Associate Professor Watkin Lui. “We’re increasingly seeing creative strategies in the Indigenous space where art forms and storytelling are being adapted as part of the knowledge transfer process.”
Leading the way internationally
Knowledge translation is at the heart of decolonising research and involves privileging Aboriginal and Torres Strait Islander research leaders and communities.
More than two-thirds (68 percent) of research projects funded by the Lowitja Institute are led by Aboriginal and Torres Strait Islander researchers, according to the Deloitte report, compared with less than 10 percent of funding by the NHMRC into Aboriginal and Torres Strait Islander health issues. Under the Lowitja Institute’s new commissioning process this figure will rise to 100 percent, with all research projects being led by Aboriginal and Torres Strait Islander organisations.
Associate Professor Watkin Lui says Indigenous knowledge transfer is being led in Australia by the Lowitja Institute, which controlled a small amount of the total research dollars but was developing critical research infrastructure. The Institute’s work is estimated to represent 0.1 percent of the total spending on health research in Australia and around 5.4 percent of the total spending on Aboriginal and Torres Strait Islander-specific health research, according to the Deloitte report.
“Lowitja Institute is leading the way internationally to provide the support that’s needed to strengthen capacity in community organisations to lead and conduct research to improve health outcomes,” says Associate Professor Watkin Lui.
Her team at James Cook University developed a two-day professional development course, Pathways to Knowledge Translation and Impact in Aboriginal and Torres Strait Islander Health Research, funded by Lowitja Institute and accompanied by a framework to plan, implement, monitor and evaluate knowledge translation and research impact.
Associate Professor Watkin Lui says she had changed her research practice after her immersion in knowledge translation in recent years.
“I don’t do projects the same way I was taught in my PhD,” she says. “It’s been a personal journey of growth and change, putting myself in the place of communities and asking what does the community want to change, and what information do they need to make those decisions.
“It’s not easy and there are challenges. Genuine community engagement takes time and can require some courageous conversations, research institutions are resistant to change and funding is always an issue.
“But my motivation is that knowledge translation is really opening up conversations about what is knowledge, how that knowledge can lead to impact, and what constitutes evidence to improve the health and wellbeing of our communities.”
Dr Mohamed says closing the gap in health and wellbeing among Aboriginal and Torres Strait Islander peoples requires sovereignty over research and the active involvement of communities to identify the issues and solutions and translate that knowledge back to the community.
“Being community controlled allows us to privilege Aboriginal and Torres Strait Islander people and organisations when it comes to allocating research funds. It means we can ensure Aboriginal and Torres Strait Islander people drive our research agenda more strongly than ever and we can do the research our people want and need,” she says.
This article was written by Linda Doherty and edited by Associate Professor Megan Williams, a Wiradjuri scholar and the Research Lead and Assistant Director of the National Centre for Cultural Competence at The University of Sydney, on behalf of Croakey Professional Services. It was sponsored by the Lowitja Institute, which had final say over the content.
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