Introduction by Croakey: Indigenous communities in Far North Queensland have told researchers that they need more services to support Social and Emotional Wellbeing (SEWB), especially for families.
A study by researchers from the University of Queensland and Mater Research Institute supported communities to identify their priorities for health research, with a focus on young families.
“Healthcare services must listen to these self-determined priorities of communities, especially because they focus on making a difference at the time it counts most – the first 1,000 days of life,” say the researchers.
The researchers involved – Associate Professor Kym Rae, Professor Bronwyn Fredericks, Professor Maree Toombs, Loretta Weatherall, Luciana Massi and Christine Nielsen – describe the study and its implications below.
Kym Rae, Bronwyn Fredericks, Maree Toombs, Loretta Weatherall, Luciana Massi and Christine Nielsen write:
The life expectancy of Australian Indigenous peoples is at least ten years lower than non-Indigenous Australians. This has resulted in significant health disparities, including three times greater maternal mortality and almost double the rates of infant mortality, higher rates of low birth weight, and child hospitalisation when compared to other Australians.
Although there has been a recent policy focus on improving health outcomes for Aboriginal and Torres Strait Islander peoples, data still shows that there has been little improvement in health and well-being outcomes for Indigenous peoples over many decades.
Interventions and support during the first 1,000 days – from conception until two years of age – are critically important. This is well evidenced. However, these interventions need to be informed by community needs.
This underscores the importance of identifying the priorities of Indigenous people’s health and medical research priorities for young families during preconception, pregnancy, post-partum, and early childhood.
Study approach
From May 2022 to February 2023, a research team from the University of Queensland, including Kym Rae (lead), Luciana Massi, and Indigenous researchers Professor Bronwyn Fredericks, Professor Maree Toombs, Loretta Weatherall and Christine Nielsen, held several yarning sessions and Delphi workshops in Far North Queensland that sought to co-identify the priorities of Indigenous communities through a co-designed and collaborative process.
Twelve yarning sessions and three Delphi workshops were held, with a total of 98 participants from three Aboriginal community-controlled services. Participant feedback responses regarding the acceptability of the study approaches were reviewed immediately following the yarning sessions, to determine if the research methods were considered suitable, and to gauge satisfaction with the research process.
Word clouds were generated from the open-ended questions on the feedback form using Nvivo 12 software (see the image below). Responses indicated that overall participation in the focus groups/yarning sessions was positive for most participants.
The qualitative analysis identified at least 100 themes and subthemes based on initial yarning sessions. One of these services provides care for women who have travelled to Cairns for birthing from the Cape and Torres Strait Island regions.
Across these services and communities, priorities were broad, from hearing, eye and dental health for kids, to managing chronic diseases during the perinatal period.
The priorities in common throughout the Far North Queensland region were Social and Emotional Wellbeing (SEWB), trauma, grief and loss, and family and domestic violence.
This article outlines the three most common priorities and provides some preliminary findings.
This research provides insight into the health research priorities of Indigenous communities that may help Indigenous community-controlled organisations to develop research initiatives and translational outcomes that focus on the needs of community members.
Social and Emotional Wellbeing
The concept of SEWB considers mental health from the holistic framework of Aboriginal and Torres Strait Islander people and how it is underpinned by the social determinants of health, family, community, health, and culture.
During this project, comments from participants reflected the necessity for mental health support and care and access to social support services and programs.
Many participants highlighted a lack of access to services supporting SEWB in the more isolated regions of FNQ. Participants described how important these facilities are for families dealing with a high burden of stressors.
Participants also pointed out how critical it is to have the right types of services with the right types of environments to deliver support.
For example, a substance abuse facility could meet the needs of families well, but if the counsellor is a bad fit, it could stop someone from attending future sessions or help-seeking behaviours when needed.
Trauma
Many Aboriginal and Torres Strait Islander families have been deeply traumatised and impacted from the ongoing effects of colonisation, systemic racist policies, and financial disadvantage. These impacts are felt across all age groups of communities with members of the Stolen Generations and their families having been through acute suffering.
In simple terms, a traumatic event is an event of such significance that you cannot escape your thoughts and feelings about it. The ramifications of these can be significant, causing challenges for the individual in their relationships with others or in extreme cases being associated with self-harming behaviours and suicide.
SEWB and mental health formed strong areas of discussion with focus groups throughout the study and trauma was a sub-theme within these categories. However, trauma was reflected in many of the stories shared by communities and included ongoing, and intergenerational trauma experienced in families and communities, as well as around birthing for women.
Widespread experiences of trauma for Aboriginal and Torres Strait Islander people has resulted in ongoing impacts on the provision of health services to Indigenous communities.
These experiences of trauma may create longstanding legacies of mistrust, particularly with institutions that include health services, education, and justice.
Family and domestic violence
Discussions related to family and domestic violence occurred at each service and were often associated with alcohol and other drugs, intergenerational trauma and mental health challenges.
Above all, safety of women and their children was prioritised for participants in focus groups; however, there was a clear lack of resourcing for this within the region.
Several participants identified that many communities in the regions of FNQ and the Cape are too small to have a women’s shelter and, due to the demand in communities where there were shelters available, they were only given a single night’s refuge. Without safe shelter, women were often forced to return to family or domestic violence situations.
A potential solution to this, considered by participants, is the provision of community safe spaces for pregnant women that are health-promoting; for example, a safe house and prioritisation for keeping women in pregnancy safe.
Message to healthcare services
Closing the gap to end Indigenous health inequalities continues to be paramount for health professionals in Australia today, as it has been since the start of the Closing the Gap social justice initiative in 2007.
This study aims to contribute to prioritising community ownership of research by identifying what the health research priorities are, through an approach guided by Participatory Action Research principles that was considered highly acceptable to community members.
The study has identified the health research needs of young families in the Far North Queensland Region of Indigenous communities.
Healthcare services must listen to these self-determined priorities of communities, especially because they focus on making a difference at the time it counts most – the first 1,000 days of life.
Acknowledgement
We acknowledge and sincerely thank the organisations and individuals who assisted us to undertake this work. It would not have been possible without your support, and collaboration. We additionally acknowledge the support of the Mater Foundation; particularly Equity Trustees (ANZ QLD Community Foundation, QCF ANZ Bank Fund, QCF – Thomas George Swallow Trust and the HJ Hinchey Charitable Trust), and the support from our UQ colleagues, including Eden Bywater, Office of Indigenous Engagement, UQ.
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