Factors Associated with Thoughts of Self-Harm or Suicide among Aboriginal and Torres Strait Islander People Presenting to Urban Primary Care: An Analysis of De-Identified Clinical Data

Suicide amongst Aboriginal and Torres Strait Islander people is a major cause of premature mortality and a significant contributor to the health and life expectancy gap. This study aimed to estimate the prevalence of thoughts of self-harm or suicide in Aboriginal and Torres Strait Islander people attending an urban primary health care service and identify factors associated with these thoughts. Multilevel mixed-effects modified Poisson regression models were employed to analyse three years of data gathered during the annual Aboriginal and Torres Strait Islander health assessments. At their first health assessment, 11.5% (191/1664) of people reported thoughts of suicide or self-harm in the prior two weeks. Having children, participating in sport or community activities or being employed full-time decreased the risk of such thoughts. Conversely, factors relating to social exclusion including homelessness, drug use, unemployment and job insecurity increased the risk of thoughts of self-harm or suicide. Individual clinicians, health services, and policy-makers all have a role in suicide prevention. Clinicians need appropriate training to be able to respond to people expressing these thoughts. Aboriginal and Torres Strait Islander community organisations need sovereignty and self-determination over resources to provide programs that promote cultural connectivity and address social exclusion, thereby saving lives.

Development of a Maternal and Child mHealth Intervention with Aboriginal and Torres Strait Islander Mothers: A Co-Design Approach (Preprint)

BACKGROUND Despite their growing popularity, there are very few mobile health (mHealth) interventions for Aboriginal and Torres Strait Islander people that are culturally safe and evidence-based. A co-design approach is considered a suitable methodology for developing health interventions with Aboriginal and Torres Strait Islander people. OBJECTIVE The aim of this study was to co-design a mHealth intervention to improve health knowledge, health behaviours, and access to health services for women caring for young Aboriginal and Torres Strait Islander children. METHODS Aboriginal researchers led engagement and recruitment with health services and participants in three Aboriginal communities in New South Wales Australia. Focus groups and interviews were facilitated by researchers and an app developer to gather information on three pre-determined themes, 1) design characteristics, 2) content modules, and 3) features and functions. Findings from the co-design led to the development of an intervention prototype. Theories of health behaviour change were used to underpin intervention components. Existing publicly available evidence-based information was used to develop content. Governance was provided by an Aboriginal Advisory group RESULTS Thirty-one mothers and 11 health professionals participated in eight co-design focus groups and 12 interviews from June to September 2019. Six design characteristics identified as important were: (1) Credibility, (2) Aboriginal and Torres Strait Islander designs and cultural safety, (3) Family centredness, (4) Supportive, (5) Simple to use, and (6) Confidential. Content modules include six modules for women’s health: (1) Smoke free families, (2) Safe drinking, (3) Feeling Good, (4) Women’s Business, (5) Eating, (6) Exercise; and six modules for children’s health: (1) Breathing Well, (2) Sleeping, (3) Milestones, (4) Feeding and Eating, (5) Vaccinations and Medicine, and (6) Ears, Eyes and Teeth. Six technology features and functions were also identified: (1) Content feed, (2) Social connection, (3) Reminders, (4) Rewards, (5) Communication with health professionals, and (6) Use of videos. CONCLUSIONS An mHealth intervention including app, Facebook page, and text message modalities was developed based on the co-design findings. The intervention incorporates health behaviour change theory, evidence-based information and the preferences of Aboriginal and Torres Strait Islander women and health professionals. A pilot study is now needed to assess the acceptability and feasibility of the intervention.

Interventions to address food insecurity among Aboriginal and Torres Strait Islander people: A rapid review

Food insecurity disproportionately impacts Aboriginal and Torres Strait Islander Australians. This review sought to investigate research and evaluations of programs and interventions implemented to address food insecurity among Aboriginal and Torres Strait Islander communities. A rapid review was conducted to collate the available research from six databases. The search was conducted in May 2020. Search constructs related to food insecurity, Aboriginal and Torres Strait Islander people, and Australia. 25 publications were included in this review, 24 reported on an intervention, while nine were evaluations of an intervention. Interventions included behaviour change projects, including projects that sought to change purchasing and cooking behaviours, school-based education programs, and gardening programs. In general, the studies included in this sample were small, and lacked a systematic consideration of the factors that shape the experience of food insecurity among Aboriginal and Torres Strait Islander people specifically. Based on the findings of this review, authors suggest greater consideration to the systematic determinants of food insecurity among Aboriginal and Torres Strait Islander communities to have lasting and sustainable impact on food insecurity. This review has been registered with the international prospective register of systematic reviews (PROSPERO: CRD42020183709). Novelty bullets • Food insecurity among Aboriginal and Torres Strait Islander people poses significant risk to health and wellbeing. • Small scale food security interventions may not provide ongoing and sustained impact. • Any intervention to promote food security will need to involve Aboriginal and Torres Strait Islander people and be sustained once external parties have left.

Disrupting the colonial algorithm: Indigenous Australia and social media

Indigenous voices and outlooks are often overlooked within public discourses in Australia and throughout the world. Settler-colonialism has resulted in centuries of dispossession, manifesting in the denial of Indigenous citizenship, autonomy and sovereignty. Throughout this article we discuss how Indigenous people are increasingly turning to social media to illuminate how colonialism continues to oppress Aboriginal and Torres Strait Islander people and communities. In doing so, Indigenous people are disrupting what we call the ‘colonial algorithms’ that shape misguided perceptions of Indigenous people and identities. Analysing Indigenous use of social media and centring our discussion around several Indigenous-led online campaigns, we demonstrate how online platforms are bringing an array of social issues to light in ways that privilege Indigenous voices and perspectives, ultimately disrupting and shifting oppressive colonial algorithms.

843Hepatitis C in South Australia and Northern Territory: a population-based linkage study

Background In Australia, the notification rate for hepatitis C is five times greater among Aboriginal and Torres Strait Islander peoples than nonIndigenous populations. Infection with Hepatitis C virus is associated with increased morbidity, mortality and health-related costs. However simple, tolerable and short-duration HCV therapies with extremely high efficacy are available. Methods Overall, this project aims to identify inequities in hepatitis C healthcare for Aboriginal and Torres Strait Islander peoples across South Australia (SA) and Northern Territory (NT). By using 19 routinely collected health administration datasets, we will evaluate hepatitis C diagnoses, treatment uptake, and treatment outcomes, with focus on identifying patterns in healthcare access among Aboriginal and Torres Strait Islander people in SA since 1992 or in NT since 1999 using probabilistic data linkage methodology in a secured online environment. Results The study population includes all hepatitis C notifications recorded in SA and NT, totaling more than 25,000 cases. Preliminary findings will be reported including incidence of hospitalisation, mortality, and morbidity by Aboriginal and Torres Strait Islander status. Conclusions Now that highly effective direct acting anti-viral treatments are available, it is crucial to ensure key affected populations, including Aboriginal and Torres Strait Islander people, have access to these novel biomedical approaches. Key messages This project is of national importance to address hepatitis C related morbidity and mortality in Australia, particularly among Aboriginal and Torres Strait Islander peoples. Findings will underpin future policy to reduce the burden of hepatitis C across SA and NT populations.

Investigating equity in access to Australian clinical genetic health services for Aboriginal and Torres Strait Islander people

Globally, there is a recognised need for a greater commitment to an equity agenda in clinical genomics and precision medicine. Fundamental to this, is the equitable access by all to services providing genomic health care. However, achieving this remains constrained by a paucity of evidence that quantifies (in)equity of access to clinical genomics, particularly amongst Indigenous populations. Using administrative data from clinical genetic health services located in three jurisdictions (States/Territories) in Australia, we investigate equity in the scheduling and attendance of appointments among Aboriginal and/or Torres Strait Islander people, compared to non-Aboriginal and/or Torres Strait Islander people. For 15554 appointments scheduled between 2014-2018, adjusted Multivariate Poisson Regression models revealed that Aboriginal and/or Torres Strait Islander people were scheduled fewer appointments (IRR 0.73 [0.68-0.80], <0.001) and attended at lower rates (IRR 0.85 [0.78-0.93], <0.001). Within this population, adults, females, people living in remote locations, and those presenting in relation to cancer or prenatal indications experienced the greatest disparity in access. As the first quantitative, multi-jurisdictional study to measure access to clinical genetic health services, these results provide important baseline data related to the reach and equity of these services in Australia and contribute to the global effort to address equity in genomic health.