Introduction by Croakey: As COVID-19 spreads throughout Queensland, it is vital to ensure Aboriginal and Torres Strait Islander Community Controlled Organisations and the Indigenous health workforce are properly resourced and supported.
Related insights come from a study conducted at the University of Queensland, previously reported on by Croakey, that has continued to use systems thinking to map responses to COVID-19 among Indigenous communities in Brisbane.
The article below is by University of Queensland researchers Professor Bronwyn Fredericks, Professor James Ward, Dr Abraham Bradfield, Dr Sue McAvoy, Shea Spierings, Troy Combo and Agnes Toth-Peter.
Bronwyn Fredericks, James Ward and colleagues write:
During 2021, researchers from the University of Queensland, led by Professor Bronwyn Fredericks and Professor James Ward, held a series of three systems thinking workshops that aimed to provide a better understanding of the complexities associated with public health responses to COVID-19 in urban Brisbane.
A range of stakeholders, who work in or are associated with the urban Indigenous health sector in Brisbane and who came from State, Federal, and Community-based organisations, participated in the systems thinking focused workshops.
In collaboration with the researchers, participants identified the following six themes that they saw as having agency and conceptually shaping part of the urban health system in Indigenous communities:
- Rates of infection and susceptibility
- Family and community
- Young people
- Indigenous workforce
- Media misinformation and vaccine hesitancy
- Vaccine uptake.
In an attempt to classify the elements and relationships between these themes, stakeholders shared their experiences of working with Aboriginal communities, and in doing so, produced a “Systems Map” that outlines the multifaceted factors that exacerbate and mitigate health risks.
Here, we’ll outline the six themes and provide some preliminary findings from the research. Our research provides insight into some of the determinants of COVID-19 transmission in urban Indigenous settings and unpacks their interrelationships with aim of identifying potential points for intervention and policy reform.
Infection and susceptibility
The number of COVID-19 cases within a community often correlates to “transmission events”. As chances of transmission events increases via public and private gatherings, so does a person’s susceptibility of infection.
Stakeholders expressed how pre-existing health conditions and discrepancies between Indigenous and non-Indigenous populations placed Aboriginal and Torres Strait Islander peoples at greater risk during such events.
As infections grow within the community, however, greater immunity may eventuate. This means that the likelihood that the event will result in more COVID-19 cases could potentially be mitigated.
Having said that, we acknowledge that this does not take variants such as Omicron into account, nor the fact that COVID-19 can be contracted multiple times.
Family and community
Developing policies that are based on Indigenous cultural protocols and practices was identified as being necessary to protect Indigenous people and boost social and emotional wellbeing.
As many community members do not trust mainstream authorities, the more prominent the role and leaderships of a trusted community member in COVID-19 responses, the greater likelihood that community members will adopt protective measures against the virus.
High mobility rates, people returning to their home communities, and difficulties in contact-tracing movements were all identified as having the potential to increase transmission. Overcrowding, inadequate infrastructure, or an inability to self-isolate were also seen to exacerbate the pressures placed on under-resourced and overworked community and family members.
Pre-existing unemployment rates alongside job losses because of COVID-19 further contributes to family pressures.
As greater expectation is placed on community leaders to provide solutions, demand on the Indigenous workforce increases as does the chances of stress, burnout, and negative impact on social and emotional well-being, which can further exacerbate the chance of transmission.
Young people
Stakeholders identified young people as a strength, and also having a significant impact on infection outcomes in urban Brisbane.
In some cases, lockdowns and “lockdown fatigue” were seen to contribute to a sense of social disconnection, disenfranchisement, and complacency.
Misguided perceptions of young people being less vulnerable, paired with the fact that many tend to be asymptomatic, can potentially boost risk-taking behaviours, result in scepticism and disregard of policies such as checking-in, and lead some towards sources of misinformation. Collectively, this has the potential to increase the number of infections in the community.
The impact of incarceration rates among the young was also identified as potentially contributing to the spread of virus. Community transmission could quickly spread into prisons, while a lack of culturally safe care has failed to prevent incarceration and provide adequate support upon an inmate’s release.
Indigenous workforce
Many stakeholders had firsthand experience with increased demand placed on the Indigenous health workforce and community leaders during COVID-19.
Over time, this has resulted in fatigue, burnout, and has the potential to impact workplace safety and productivity. This can adversely affect staff retention which in turn places greater demand on the remaining workforce.
Providing culturally safe care was identified as an effective way of tailoring responses towards Indigenous people’s needs, while also promoting trust, alleviating demand on the workforce, and creating a safe and welcoming environment.
While stakeholders emphasised that Indigenous health workers and Community Controlled Health Organisations are best positioned to provide culturally informed, integrative, and holistic responses to COVID-19, these services and personnel must be adequately funded, resourced, and supported across all levels of government.
Media misinformation and vaccine hesitancy
Traditional media (newspapers, television, radio etc), as well as online and social media, have been vital to communications and messaging relating to COVID-19.
Negative reporting through use of stereotypes, tropes, and spin were seen by stakeholders to jeopardise the credibility of health messaging. This may potentially reinforce Indigenous peoples’ mistrust in mainstream authorities.
Stakeholders expressed how snapshot reporting and a “one size fits all” approach to media coverage contributed to some people seeking alternate sources of information, increasing their chances of being exposed to unverified and often false information.
COVID-19 literacy was found to correlate to the credibility that community members attributed to the information they encountered.
As disproportionate and biased reporting decreases and Indigenous voices become more pronounced, stakeholders expressed that credibility attributed to communications could potentially improve, along with COVID-19 literacy and protective behaviours.
Vaccine uptake
Some stakeholders expressed that from their experience, vaccine uptake correlated to a sense of urgency and lived experience with COVID-19.
As COVID cases have been relatively few in Queensland, communities have not been as driven to get vaccinated in comparison to other states.
Issues pertaining to inequities in service delivery, and a healthcare system that largely fails to accommodate Indigenous cultural safety protocols, were also identified as impacting vaccination uptake.
Discrimination towards Indigenous people at vaccination hubs, or other negative experiences relating to COVID-19 policies, can quickly circulate within communities, further increasing vaccine hesitancy and escalating susceptibility to misinformation.
Stakeholders expressed how many Indigenous people, who are classified as a “vulnerable population”, believed that as early qualifiers for the vaccine they were being treated as guinea pigs or test cases.
Narratives such as these have the potential of fuelling anti-vaccination discourses and can take hold in some communities, contributing to low vaccination rates.
Conclusion
Systems thinking provides an “intuitive language” that enables specialists from different fields and professions to speak on common terms and better understand complex problems that require multi-faceted approaches.
The systems map produced as part of this research presents the complex challenges of navigating health crises such as COVID-19.
The visual map highlights the touchpoints for interventions (as identified and discussed by participants) while also drawing attention to the policies and practices in need of reform to achieve better health outcomes in both remote and urban Indigenous communities.
This project is funded through the National Health and Medical Research Council Centre of Research Excellence (NHMRC CRE), the Australian Partnership for Preparedness Research on Infectious Disease Emergencies (APPRISE, AppID 1116530) through a donation from the Paul Ramsay Foundation.
See the list of references for this article.
See Croakey’s archive of stories on cultural safety.
