Projects Supported

Please Note:All KAMSC research projects, which have been submitted to the Kimberley Research Subcommittee, are listed under current or completed projects.

Click the project titles below to expand information:

Reference: 2007-004 - Improving wound care in Indigenous communities in WA a partnership with Indigenous communities to develop culturally inclusive approaches to prevention and management of complex wounds

Researchers: Dr Rhonda Marriott (Murdoch University), Professor Anne McMurray (Murdoch University), Assoc Prof Keryln Carville (Silver Chain and Curtin University), Jenny Prentiss (Nurses Board of WA), Veronica Strachan (Wounds West)

Funding: State Health Research Advisory Council

Project summary: This project aims to improve wound healing rates and access to best practice management of complex wounds in Indigenous communities across Western Australia through a culturally inclusive approach.

This will include: the incorporation of Indigenous beliefs and perspectives into patient management and treatment protocols; the implementation of education and health promotion programs; and interventions aimed at prevention, early detection and effective management of wounds. Expected outcomes of the project include increased awareness of wound assessment, wound complications and management; increased skill levels of health practitioners (particularly of the Indigenous health workforce); improved appropriateness of referrals to acute WA health centres; improved healing rates of wounds; a decrease in amputations (and other complications); and increased access to culturally appropriate best practice wound management by Indigenous patients. It is anticipated, based on a previous pilot conducted in the Kimberley region that significant cost savings will be realised within the duration of this project and will be sustained beyond the life of the project.

The project will be led by Aboriginal researchers supported by highly qualified senior clinicians and scientists. Funding was received in August 2007 and the project will end in July 2008. Provision will be made for a follow up evaluation to be conducted 12 months after the project has concluded to measure sustainability of the outcomes of this project.

Progress: Completed in 2009

Reference: 2007-006 - The Longitudinal Study of Indigenous Children (LSIC) / Common name: Footprints in Time

Researchers: Pam Hunter (Derby Research Administration Officer, Department of Families, Community Services and Indigenous Affairs (FaCSIA)), Dr Melisah Feeney (Project director, FaCSIA), Graham Brice (Ethics and Research, FaCSIA)

Funding: Australian Government through FaCSIA

Project summary: Footprints intends to work with Aboriginal and Torres Strait Islander families in 11 regions across Australia, including Derby, Fitzroy Crossing and the surrounding communities to help better understand what impacts on children’s lives over time and explore how they can be better supported to grow up strong and resilient regardless of location. The study will concentrate on babies (6-18 months) and 3½-4½ year olds. It is overseen by a Steering Committee chaired by Professor Mick Dodson (ANU), and includes Adele Cox of the Kimberley region. The Committee has mandated that Footprints in Time must be designed and conducted so that it has the acceptance and support of Aboriginal and Torres Strait Islander communities and of participating families. The key research questions have been developed following consultation with Aboriginal and Torres Strait Islander communities around Australia, as well as Government departments and service providers, to identify areas where longitudinal research would provide useful information. The key questions are:

  • What do Indigenous children need to have the best start in life to grow up strong?
  • What helps Indigenous children to continue to grow healthy, positive and strong?
  • What is the importance of family, extended family and community in the early years of life and when growing up.
  • What differences are there between how Indigenous children are raised compared to non-Indigenous children.

Communities also have the opportunity to request additional questions be included at the local level. All requests for additional questions go to the LSIC steering committee. This is the first longitudinal study of Aboriginal and Torres Strait Islander children across Australia. This means that parents/carers will be asked for permission to be re-interviewed at least every year for four years or longer.

Progress: Ongoing

Reference: 2008-001 - Alcohol and Pregnancy: Aboriginal Women’s knowledge, attitude and practice

Researchers: Heather D’Antoine (Telethon Institute for Child Health Research), Nadine Henley (Edith Cowan University), Jan Payne (Telethon Institute for Child Health Research), Elizabeth Elliott (University of Sydney), Carol Bower (Telethon Institute for Child Health Research), Anne Bartu, (Drug and Alcohol Department)

Funding: Healthway Starter Grant

Project summary: The aim of this project is to collect qualitative data from Aboriginal women in the Kimberley (Fitzroy Crossing), Goldfields and the Metropolitan area on their knowledge, attitudes and practice regarding alcohol use in pregnancy. The data will be collected through focus groups. Data from non-Aboriginal women on this topic has already been collected through a computerised telephone survey. As anticipated, Aboriginal women were under-represented in this survey and it was planned that we would collect qualitative data from Aboriginal women on this topic. This information will be used to inform the development of an intervention aimed at informing women and the broader community about the effects of alcohol use in pregnancy. The data collection in the Kimberley and Goldfields is funded by a Healthways Starter Grant. The data collection for the Metropolitan area, which has commenced, is funded through the current NHMRC Program Grant.

Progress: Completed in 2009

Reference: 2008-004 - Monitoring carriage of Streptococcus pneumoniae among Aboriginal children and adults in Western Australia

Researchers: Deborah Lehmann, Anke Bergmann (Telethon Institute for Child Health Research), Paul van Buynder & Carolien Giele (Communicable Diseases Directorate, Western Australian Department of Health), David Smith & Jacinta Bowman (Division of Microbiology and Infectious Diseases, PathWest Laboratory Medicine), Amanda Leach & Kim Hare (Menzies School of Health Research, Darwin)

Funding: Department of Health WA

Project summary: The bacterium Streptococcus pneumoniae (pneumococcus) can cause middle ear infection and invasive pneumococcal disease (IPD) resulting in meningitis, pneumonia and blood poisoning. The Australian Aboriginal population has among the highest reported IPD rates worldwide. The existence of 90 different types (serotypes) of pneumococci increases the challenge of prevention, particularly vaccine development. A vaccine covering the 7 most common serotypes (Prevenar) and a booster with a vaccine covering 23 serotypes (Pneumovax) is offered to Aboriginal children. Pneumovax is also offered to Aboriginal adults. Following the introduction of Prevenar in 2001 incidence of IPD has fallen in children, though the serotypes causing disease are not entirely those not included in Prevenar. Further cause for concern is a marked increase of IPD in Aboriginal adults, also predominantly due to serotypes not included in the Prevenar vaccine. The likelihood of replacement diseases due to non-vaccine serotypes needs further investigation. Surveillance of IPD is hampered because antibiotics are often given before there is an opportunity for collecting blood cultures, particularly in remote parts of WA. However pneumococci are carried in the back of the nose of healthy individuals (up to 50% of Aboriginal children and more than 25% of Aboriginal adults). Carriers can transmit pneumococci to other members of the community. Surveillance of pneumococcal carriage can assist in predicting emerging serotypes causing IPD and susceptibility of pneumococci to antibiotics. Furthermore, carriage studies can assist in developing appropriate policies with regard to the next generation of pneumococcal vaccines, two of which are likely to be licensed in Australia soon.

Progress: Ongoing

Reference: 2008-006 - Establishing Breastfeeding Trends in Kununurra

Researchers:Trish Graham (Kimberley Public Health Unit (KPHU), Tracy Leon (Kimberley Division of General Practice), Hanneke Schoe (KPHU), Noelene Bending (KPHU), Margaret Williams (Ord Valley Aboriginal Health Service), Brenda Walters (Kununurra District Hospital)

Funding: Internal

Project summary: not provided

Progress: Completed in 2011

Reference: 2008-007 - Good Medicine Better Health Project Evaluation

Researchers: Linda Klein (National Prescribing Service), Meg Stuart (National Prescribing Service), Michele Robinson (Aboriginal Health Council of South Australia)

Funding: National Prescribing Service

Project summary: There is a need for Aboriginal people to be better informed about how to use their medicines wisely and safely. Aboriginal Health Workers (AHWs) who work in Aboriginal Health Services are well placed to help their clients with medicine issues. The Good Medicines Better Health project provides training for AHWs about quality use of medicines (QUM), focusing on 3 chronic conditions where medicines use is common – hypertension, diabetes and asthma. The project uses a train-the-trainer strategy. Senior AHWs have become trainers and have begun to train local AHWs at KAMSC. This evaluation will focus on how QUM training has helped local AHWs function more effectively with clients in promoting QUM. A qualitative methodology is proposed with questions focusing on how AHWs respond to QUM training and use the information in their work with clients. A week of evaluation activities is planned at KAMSC, using observational methods to assess the practices of AHWs within the context of their daily work. Observation will be conducted by the AHW trainers or a local worker (to be identified) with which AHWs are comfortable. Only de-identified summary data will be collected for clients who have provided verbal permission for observation. An NPS evaluation staff member will be at KAMSC to discuss the observations, assist with record keeping, conduct discussion groups with AHWs, analyse findings and prepare a report for KAMSC and program stakeholders.

Progress: Completed in 2009

Reference: 2008-008 - Improved communication and informed decision making by Aboriginal and Torres Strait Islander families: Antenatal diagnosis, neonatal care, and end of life decisionsn

Researchers: Dr Roz Walker (Telethon Institute of Child Health Research)

Funding: Department of Health Office of Aboriginal Health

Project summary: This research is being conducted by the Telethon Institute for Child Health Research (the Institute) in collaboration with the WA Department of Health’s Women’s and Newborns Health Network (WNHN) and the Office of Aboriginal Health. This project explores the communication and decision-making processes surrounding prenatal, neonatal and end of life decisions between Aboriginal families, their communities and health care providers. It aims to develop more effective and culturally appropriate practices and procedures, to improve communication between health care professionals and Aboriginal women and their families in relation to prenatal diagnosis, neonatal intensive care, and end of life decisions. It also aims to develop resources for health care professionals and allied staff to increase their understanding of the cultural issues and complexities faced by Aboriginal families when prenatal, neonatal and end of life decisions are required; as well as identifying culturally appropriate resources to support Aboriginal families to make health care decisions when experiencing the death or dying of an infant/child.

Progress: Completed in 2011

Reference: 2008-009 - Broome Diocese Child Protection Response Project

Researchers: Vickie Hovane (Principle Researcher, Contracted to Notre Dame University Australia Broome), Joe Edgar (Research/ Community Facilitator, Nulungu Centre for Indigenous Studies, Notre Dame University Australia Broome), Steve Kinnane (Acting Assoc. Dean Arts and Sciences, Nulungu Centre for Indigenous Studies, Notre Dame University Australia Broome)

Funding: Caritas Australia

Project summary: The aim of the research project is to consult with Catholic Religious Congregations, Church personnel and school staffs in the Kimberley which have been associated with the Broome Diocese over a period of time on the issue of Child Protection. The project will seek feedback from these groups on the preventative, educative or healing responses, or lack thereof, currently in operation through the Diocese as a means of ensuring child protection for children engaged by these institutions. The research will be overseen by a reference group of Indigenous and non-Indigenous workers associated with the Broome Diocese. The results of the research will be utilised to guide the Broome Diocese in ensuring adequate and effective responses are actioned to prevent child abuse in any institutions or communities within the Diocese through educative, healing and program support.

Progress: Completed in 2009

Reference: 2008-010 - National Indigenous Eye Health Survey

Researchers: Prof Hugh Taylor (University of Melbourne), Prof Jill Keeffe, Sarah Fox & Anna-Lena Arnold (Centre for Eye Research Australia)

Funding: RANZCO Eye Foundation, Vision CRC

Project summary: The National Indigenous Eye Health Survey is designed to provide essential baseline evidence for future use in planning and prioritising the effective delivery of eye care to Indigenous Australians. The Survey is designed to assess the prevalence and main causes of vision impairment, the utilisation of eye care services, barriers to health and the impact of vision impairment on people. The survey utilises and relies upon a broad spectrum of expertise within the Indigenous health and eye health sectors. The structure of the project, with its state and national participating organisations, will produce meaningful information about the true extent of Indigenous eye health. This survey will provide definitive and quantitative data from which organisations around the country can advocate and plan service delivery to enhance existing services and develop new referral services. The implementation of effective eye health services will improve the health status of Indigenous people. The final report will provide the necessary information for the Government’s National Eye Health Framework. The ultimate goal is to provide the evidence base for the provision of eye care services so they will be available, accessible and appropriate for all Australians.

Progress: Completed in 2009

Reference: 2008-011 - The Rio Tinto Aboriginal Health Partnership: Building a strong foundation and sustainable future

Researchers: Prof Fiona Stanley (Telethon Institute for Child Health Research), Prof Colleen Hayward, Dr Clair Scrine & Heather Monteiro (Kulunga Research Network, Telethon Institute for Child Health Research)

Funding: Rio Tinto Ltd

Project summary: This Project responds to a call from Aboriginal Health Workers for more training, development and support. It aims to build the capacity of Aboriginal Health Workers, Aboriginal community controlled health organisations and government agencies, and the Aboriginal community through the development and provision of practical tools and programs to bring about improvements in the area of Aboriginal child and maternal health. This will be achieved through the development of a toolkit which will provide ongoing assistance to individuals and organisations. Content of the toolkit will include the topics addressed through community consultation, as well as a range of other information and resources relevant to Aboriginal maternal and child health. The toolkit will also provide resources which aim to build the capacity of Aboriginal Health Workers by providing them with the skills and knowledge to conduct their own research.

Progress: Completed in 2010

Reference: 2009-001 - Vitamin D deficiency in Aboriginal children and adolescents in metropolitan and rural Western Australia

Researchers: Dr Jason K Tan, (Paediatric registrar), Dr Andrew Martin (Supervisor, Gen. Paediatrician/Metabolic consultant), Dr Aris Siafarikas (Endocrinology consultant), Princess Margaret Hospital

Funding: Internal

Project summary: Vitamin D plays a key role in strengthening bones to help prevent fractures. Less well recognised, but possibly even more important are the roles vitamin D plays in supporting the immune system to help fight infections and in protecting against certain forms of cancer and diabetes. Humans produce vitamin D in their skin under the influence of sunlight. Lack of sun exposure and dark skin increase the risk of vitamin D deficiency.

At Princess Margaret Hospital, up to 80% of children seen at the Refugee Clinic (predominantly of African origin) are vitamin D deficient. These children require vitamin D supplementation, which can be given either in small doses each day or in a high dose at six-weekly intervals (“depot therapy”). Although there are no published studies examining the prevalence of vitamin D deficiency in Australian Aboriginal children, it seems highly likely that those children with darker skin who do not get regular sunlight exposure will also be at very high risk of vitamin D deficiency.

The aims of this study are to determine the prevalence of vitamin D deficiency in Aboriginal children from metropolitan and rural settings in Western Australia (WA); to examine the relationship between vitamin D levels and childhood infections; and to determine if depot and daily vitamin D therapy have the same therapeutic outcomes.

Progress: Completed in 2013

Reference: 2009-002 - Evaluation of the Halls Creek Mother’s Support Initiative – ‘Yanan Ngurra– ngu Ngamayiu’

Researchers: Dr Roz Walker (Telethon Institute of Child Health Research), Valma Banks (Aboriginal Program Manager, HCMSI), Aboriginal community care workers (Halls Creek Mother’s Support Initiative)

Funding: Department of Health Western Australia

Project summary: The Halls Creek Mother’s Initiative –‘Yanan Ngurrangu Ngamayiu’ is a community-based maternal and child health prevention and education program for pregnant women and parents of young children in Halls Creek Halls Creek and the immediate surrounding communities which commenced in April 2008. This program aims to draw together the combined skills, knowledge and experience of local Aboriginal women and health professionals and other service providers to improve birth and developmental outcomes and mother’s wellbeing and capacity. This study is important to find out about the experiences of program participants and staff and whether the program is helping to change things positively for the women, children 0-3 years and the community.

Progress: Completed in 2011

Reference: 2009-003 - Accurate assessment of renal function and progression of chronic kidney disease in Indigenous Australians

Researchers: Dr Louise Maple-Brown (Menzies School of Health Research, Darwin), Dr Paul Lawton (Director, NT Renal Services), Prof Kerin O’Dea (Director, Sansom Institute, Uni SA), Prof Wendy Hoy (University of Queensland), Dr Alan Cass (The George Institute), Prof George Jerums (Austin Health, Melbourne), Dr Mark Thomas (Royal Perth Hospital), Dr Kevin Warr (Royal Perth Hospital), Dr Jaqui Hughes (Menzies School of Health Research), Dr Graham Jones (SydPath, St Vincents Hospital, Sydney)

Funding: NHMRC project grant 545202, 2009-2011

Project summary: There is an overwhelming burden of chronic kidney disease and end-stage renal failure in Indigenous Australians. It is vital that we are able to accurately measure kidney function in this high risk population. Glomerular filtration rate (GFR) is the best overall marker of kidney function. However, differences in body build and body composition between Indigenous and non-Indigenous Australians suggest that estimates of GFR derived for European populations may not be appropriate for Indigenous Australians. The burden of kidney disease is borne disproportionately by Indigenous Australians in central and northern Australia, with significant heterogeneity amongst these groups, thus differences in body build and body composition likely also affect the accuracy of GFR between different Indigenous groups.

By assessing kidney function in these high-risk Indigenous Australian populations from Northern Queensland, Northern Territory, and Western Australia, we aim to determine a validated and practical measure of GFR suitable for use in all Indigenous Australians. We will compare the accuracy of the following techniques to measure GFR to the reference GFR measured by the plasma disappearance rate of iohexol: Modification of Diet in Renal Disease 4 variable formula (MDRD-4), Cockcroft-Gault formula and cystatin C. Detailed assessment of body build and body composition will be performed using anthropometric measurements, skinfold thickneses and bioelectrical impedance and a sub-study in larger centres will use dual-energy absorptiometry (DXA). It is possible that these measures may enable a modification (derived from a simple measure of fat free mass in each participant) to be incorporated into the MDRD formula for estimating GFR. Alternatively, a biochemical measure of kidney function other than serum creatinine may be found to be the most reliable measure of kidney function in all Indigenous Australians. We do not believe that a single correction factor (similar to that for African Americans) is appropriate or practical for Indigenous Australians. Once eGFR methods are validated by this study it would lay the foundations for future interventional studies that aim to ameliorate the progression of kidney function to ESRF in Indigenous Australians.

Progress: Ongoing

Reference: 2009-006 - Review of workforce capacity in Indigenous tobacco control

Researchers: Anke van der Sterren, Viki Briggs, Terry James, Dallas Young, Nicole McMillan (Centre for Excellence in Indigenous Tobacco Control (CEITC), University of Melbourne)

Funding: Department of Health & Ageing

Project summary: Smoking is a major contributing factor to Indigenous poor life expectancy and remains comparatively high (Indigenous 51%, other Australians 19%). Indigenous Healthcare workers (IHWs) are key to improving Indigenous health through their multifaceted role as community members and trusted knowledgeable professionals. Their workload is high while their capacity to meet the demand is low, and they face particular challenges in providing tobacco control programs in their communities. The Department of Health & Ageing (DoHA) have funded the CEITC to undertake a national review and consultation across the country to assess the capacities and needs of the workforces in Indigenous health services to effectively deliver tobacco prevention and cessation activities and programs. The findings of the review and consultation process will result in recommendations to DoHA on the strategic directions for its Indigenous Tobacco Control Initiative.

Progress: Completed in 2011

Reference: 2009-007 - Perspectives about child sexual abuse: Towards a theory of child sexual abuse in an Aboriginal community

Researchers: Victoria Hovane (nee Martin), Professor Alfred Allan, Dr M Allan (Edith Cowan University, Joondalup)

Funding: Internal

Project summary: The sexual abuse of children in Aboriginal communities continues to be a critical social problem in Western Australia. This research will investigate local Aboriginal understandings about child sexual abuse, what it looks like, how it is experienced, what are the barriers to addressing the issue and how those barriers can be overcome. A qualitative methodology utilizing a grounded theory approach and involving semi-structured interviews will be used. The interviews will be conducted with a minimum of 12 adult Aboriginal men and 12 Aboriginal women or until saturation is reached. Each interview will be audio-taped and transcribed. Thematic content analyses will be conducted on the transcribed data and the results used to develop a theoretical framework about child sexual abuse in the local Aboriginal community. This framework will be verified through two forums; one with a community group, and the other with a group of workers and professionals. The resultant framework may then be used to inform policy development and strategies for addressing the issue.

Progress: Completed in 2013

Reference: 2009-008 - Research Project to Engage Children and Young People About Views of Their Wellbeing

Researchers: Jan Saggers, Marie Finlay, Maxinne Sclanders, Jan Stuart, Caroline Adupa, Issihaka Toure, (Nexus Strategic Solutions), Mary Sankey (Sankey Associates), Dr Janet Fletcher (UWA Child Study Centre), Yarmintali (Rhonda) Murphy, (Yarmintali Consultancy)

Funding: Commissioner for Children and Young People

Project summary: The purpose is to conduct research with children and young people about their views on wellbeing. The specific objectives are to ensure research conducted obtains the views and perspectives of children and young people across Western Australia on what is important to their wellbeing and engages directly with a mix of children and young people across Western Australia, including Aboriginal and Torres Strait Islander and vulnerable or disadvantaged children and young people.

Progress: Completed in 2010

Reference: 2009-009 - STRIVE: STI in Remote communities: ImproVed & Enhanced primary health care

Researchers: Prof John Kaldor, Mr James Ward, Dr Rebecca Guy, Prof. Lisa Maher, Prof. Basil Donovan, A/Prof Matthew Law (National Centre in HIV Epidemiology and Clinical Research); Dr Alice Rumbold, Ms Bronwyn Silver, Ms Debbie Taylor-Thomson (Menzies School of Health Research); Dr Steven Skov (Northern Territory Department of Health and Families); Dr John Boffa, Ms Donna AhChee (Central Australian Aboriginal Congress); Prof Robyn McDermott (The University of South Australia); Professor Christopher Fairley (University of Melbourne)

Funding: National Health and Medical Research Council

Project summary: STRIVE is a collaborative research project between the National Centre in HIV Epidemiology Clinical Research and the Menzies School of Health Research in partnership with the Aboriginal Medical Services Alliance Northern Territory, the NT Department of Health and Families, Apunipima Cape York Aboriginal Health Council and the Kimberley Aboriginal Medical Services Council. STRIVE aims to reduce the short and long-term adverse consequences of sexually transmitted infections (STIs). It is being implemented in the Kimberley to address the recognised endemic rates of STIs occuring in Aboriginal communities in this region.

Progress: Ongoing

Reference: 2009-010 - Risky Business

Researchers: Juan Fernando Larranaga, Nkandu Beltz (Save the Children); Richard Chenhall, Kate Senior (Menzies School of Health Research)

Funding: Department of Health – WA

Project summary: The proposed action research project will inform development of a program of activities for young people throughout the Shire of Wyndham, East Kimberley (SWEK) aimed at reducing harms arising from risky sexual activity. The program will be managed by the Department of Child Protection, and contracted to the recently developed Kununurra Youth Service. Save the Children already operates youth projects in both Wyndham and Kununurra, and have established solid relationships with a range of young people and their families in each area. Save the Children works closely with relevant stakeholders engaged in the delivery of sexual health services in the region. The current project will build on these established youth networks, and related community networks as a basis for further program design and development. Young people, stakeholders and other community members will be involved from early stages in determining and delivering relevant research strategies, which we anticipate will follow a peer-education model. The proposed project will link in with, and add value to, an existing youth led sexual health project being run by Save the Children in collaboration with the YBMAD youth group in Kununurra. It will also inform development of a large scale sexual health research project due to commence in 2010 which will employ similar participatory processes throughout three states of Australia.

Progress: Completed in 2010

Reference: 2009-011 - Evaluation of Rural/Remote-Tertiary Paediatric Partnership Program

Researchers: Ms Sue Peter, Nursing Director Ambulatory Care Services (Princess Margaret Hospital)

Funding: State Health Research Advisory Council

Project summary: At PMH in 2007 there were approximately 2,000 hospital admissions and 10,000 outpatient appointments for children residing in rural/remote areas. A large number of these (approximately one quarter) were from the Kimberley and Goldfield regions. Of the OPD appointments, approximately 1,600 were not attended. The average length of stay for these children was 4.6 days, compared with 2.9 days for children residing in the metropolitan area. In the current climate of increasing hospital demand and a shift towards Ambulatory Care Services it was deemed necessary to introduce an alternative, economically viable model of care coordination. The model of care trialled in this research study offers an integrated care coordination/case management program for children who live in the rural and remote regions. This partnership coordinated program, between the Kimberley and Goldfield health services and PMH, aims to reduce the need for unnecessary travel to PMH, reduce length of hospital stays, and increase the usage of local health services with the support of PMH. This research study is designed as an interventional study and the aim is to test the following hypotheses:

  1. The Rural/Remote – Tertiary Paediatric Partnership Program will provide significant economic benefit to the WA health service through the reduction in hospital admissions, hospital length of stay and outpatient appointments within Princess Margaret Hospital, and reduction in the use of Patient Assisted Travel Scheme (PATS) by rural/remote health services.
  2. The rural/remote care coordination program is a model of care that achieves improved health care utilitsation and is highly evaluated by families.

Progress: Completed in 2011

Reference: 2009-013 - Management of coronary heart disease in the Indigenous population in Western Australia: from information to action

Researchers: A/Prof Sandra Thompson Kate Taylor (Curtin University); Emeritus Prof Michael Hobbs, Dr Frank Sanfilippo, Prof Peter Thompson, Dr Tom Briffa, Dr Judy Katzenellenbogen, Kaylene Piercy (The University of WA)

Funding: National Health and Medical Research Council Grant

Project objectives: To describe the extent of and likely reasons for inequities in medical care of cardiovascular disease in Indigenous Western Australians compared with care received by the non-Indigenous population, using acute coronary heart disease as a model.

Progress: Completed in 2010

Reference: 2010-001 - Marulu, The Lililwan (little ones) Project. Fetal Alcohol Spectrum Disorders (FASD) Prevalence Study, Determinants of health and wellbeing in a cohort of 7-year old children in the Fitzroy Valley

Researchers: Prof Elizabeth Elliott, A/Prof Jane Latimer, Dr James Fitzpatrick, Ms Barbara Lucas (The George Institute for Global Health); Ms Maureen Carter (Nindilingarri Cultural Health Services); Ms June Oscar Marninwarntikura Women’s Resource Centre); Prof Carol Bower (Telethon Institute for Child Health Research), Prof John Boulton, Ms Robyn Doney (WA Country Health Services)

Funding: The Australian Government Departments of Health and Ageing and Families and Housing, Community Services and Indigenous Affairs.

Project summary: Indigenous leaders in the Fitzroy Valley (Kimberley, WA) initiated a partnership between Nindilingarri Cultural Health Services (Fitzroy Crossing), the George Institute for Global Health and the University of Sydney Medical School to conduct a FASD prevalence study (the Lililwan Project), including experts in local Aboriginal culture, Indigenous health, paediatrics, epidemiology and Human Rights. The prevalence study is part of a broader community strategy to overcome FASD and Early Life Trauma in the Fitzroy Valley. There is strong community support for leadership and collaboration in the Project. Stage 1 of the Project (data collection completed in August 2010) involved collection of demographic, prenatal, neonatal and early childhood data from 127 parents/carers of children born in 2002 or 2003 using a questionnaire (diagnostic checklist developed in consultation with the local community), as well as delivery of a community and service provider education program. There was a 95% participation rate within the target cohort of 134 children. This final stage of the prroject relates to the Interdisciplinary FASD Diagnostic Assessments in ~130 children born in 2002 or 2003 residing in the Fitzroy Valley. The interdisciplinary medical and neurodevelopmental assessment will be comprehensive, evidence-based, and tailored to the remote clinical context. It has been developed in consultation with Nindilingarri Cultural Health Services and the local health and education workforce and was trialled in 6 children at Fitzroy Crossing in November 2010. The clinical team consists of Aboriginal health workers, a paediatrician, school health nurse, physiotherapist, occupational therapist, speech pathologist, and psychologist. Aboriginal health workers have been employed and trained in research methods specific to this study (local community navigators) and they facilitate all interactions between the research team and participants.

Progress: Ongoing

Reference: 2010-003 - Antibiotics for Asymptomatic Acute Otitis Media - AAAOM

Researchers: A/Prof Peter Morris, A/Prof Amanda Leach, Dr Heidi Smith-Vaughan, Prof Anne Chang, Dr Ruth Lennox(Menzies School of Health Research); Dr Patricia Valery (Queensland Institute of Medical Research); Prof Paul Torzillo (Royal Prince Alfred Hospital)

Funding: NHMRC

Project summary: Remote Aboriginal children have the highest rates of severe ear infection reported in the medical literature. At any time, large numbers of children have a bulging eardrum (acute otitis media) but most are completely asymptomatic. In a previous antibiotic study, acute otitis media (AOM) persisted in 50% of children after 1 week of treatment. In terms of clinical success, it didn’t make any difference whether azithromycin or amoxicillin was used (although azithromycin seemed to be better at reducing the level of infection). Currently local clinicians are: i) uncertain whether antibiotics make any difference at all; and ii) reluctant to devote resources to case-finding without good evidence of substantial benefit. In this randomised controlled trial, we will determine the benefits of two doses of azithromycin given one week apart in children with asymptomatic acute otitis media. The results of the trial will become the best available evidence to guide the medical management of asymptomatic AOM in high-risk children. It is anticipated that this research will make an important contribution in the shift toward more effective prevention and management of otitis media in Australian Aboriginal children. It will also have implications for all disadvantaged populations where adverse outcomes are common and compliance with recommended treatment is poor.

Progress: Ongoing

Reference: 2010-004 - The prevalence of Vitamin D deficency in Antenatal clients in the Kimberley

Researchers: Margaret Williams (Flinders University / Ord Valley Aboriginal Health Service)

Funding: Internal

Project summary: The prevalence of vitamin D deficiency in antenatal clients in the Kimberley. This will be done through data collection from patient information systems and will not require the clients to have any extra testing done or to complete any surveys or questionnaires. The data will be collected and assessed according to the levels of vitamin d during pregnancy and all data will be de-identified. The final results will include only vitamin D level, indigenous status and health service attended. The data will be made available to KAMSC to include in the antenatal protocol if warrented.

Progress: Completed in 2011

Reference: 2010-006 - Evaluation of screening instrument for Aboriginal mental health and well being

Researchers: Asst/Prof Zaza Lyons, Prof Aleksandar Janca, Assoc/Prof Jon Laugharne, Dr Sophie Davison (The University of Western Australia)

Funding: Internal

Project summary: The concept of social and emotional wellbeing in an Aboriginal context describes an holistic view of health recognised by many Aboriginal people. Traditionally, health encompasses more than just the physical health of an individual – the social, emotional, spiritual and cultural wellbeing of the whole community is essential for the good health of individuals within the community. Conventional screening and assessment instruments, based on unfamiliar concepts and/or symptomatology; different use of language; and the use of numerous questions by strangers may lead to misdiagnosis of mental health problems or be unacceptable to Aboriginal people. While there are many screening instruments that are commonly used by clinicians and researchers to assess a range of psychological conditions, none have been validated in the Aboriginal population. In addition, there are few assessment tools that have been specifically developed and validated for use in the Aboriginal population. The development of a culturally appropriate, simple to use, screening tool would be of benefit in assessing the social and emotional wellbeing of Aboriginal people. The Here and Now Aboriginal Assessment (HANAA) has been developed by the School of Psychiatry and Clinical Neurosciences at the University of Western Australia as a means of screening for mental health problems among Aboriginal people. It focuses on the current mental and physical health of the individual. The following ten domains are assessed by conducting a semi-structured interview: general feeling; physical health; mood; suicide risk/self harm; substance use; memory; unusual experiences; functioning; contributing factors; and resilience. Each domain is rated jointly by the interviewer and respondent as being either not a problem; a small problem; or a big problem. A descriptive narrative can be recorded by the interviewer for each domain. Guidelines to assist the interviewer have also been developed. The purpose of this research project is to evaluate the feasibility, acceptability, reliability and validity of the HANAA in the adult Aboriginal population. On completion of the validation process the instrument could be a useful tool in assessing Aboriginal people presenting with possible mental health problems in a variety of settings, including remote communities, or regional and metropolitan centres.

Progress: Ongoing

Reference: 2010-008 - Creating cultural empathy and challenging attitudes through Indigenous narratives

Researchers: Prof Colleen Hayward, Prof Cobie Rudd, A/Prof Moira Sim, Ms Toni Wain (Edith Cowan University)

Funding: Australian Learning and Teaching Council

Project summary: This is a two-year project (commenced May 2010), funded by Australian Learning and Teaching Council Ltd, an initiative of the Australian Government Department of Education, Employment and Workplace Relations. The project has two primary aims:

  • to positively influence the health and wellbeing of Australian Indigenous people by improving the education of health professionals;
  • to engage students with authentic stories of Indigenous people’s experience of healthcare, both positive and negative, which enhance the development of deep and lasting empathy.

Progress: Completed in 2012

Reference: 2010-009 - Audit of ENT referrals and management practices in the Fitzroy Valley region

Researchers: Dr Adam Mossenson, Dr Sharon Nowrojee (KPHU); Dr Sarah Larkins (JCU)

Funding: Internal

Project summary: Ear Nose and Throat conditions represent a significant health concern for Australia’s Indigenous population, especially in rural and remote areas. Service provision of ENT specialists in the Kimberley region is a limited and every effort must be made to maximise on their time when available. Currently patients are referred to ENT outpatient clinics from GPs, remote area clinics and ACCHOs without any formal review of content/completeness of the referral prior to being seen in clinic by the specialist. This project aims to review the quality of the referral letters and clinical information provided to the visiting ENT surgeons. Further, case files will be reviewed in regards to management, follow up and adherence to clinical protocols.

Progress: Did not commence

Reference: 2010-010 - Cost minimisation analysis of visiting ENT surgical service

Researchers: Dr Adam Mossenson, Dr Sharon Nowrojee (KPHU); Dr James Allen (Derby Hospital); Dr Sarah Larkins (JCU)

Funding: Internal

Project summary: Ear Nose and Throat conditions represent a significant health concern for Australia’s Indigenous population, especially in rural and remote areas. Service provision of ENT specialists in the Kimberley region is a limited and every effort must be made to maximise on their time when available. Surgical visits to the Kimberley are limited and in the past have not been optimally taken advantage of due to a range of factors such as the process of notification of patients, non-attendance on surgical days and inability to gain consent. One month to the visiting ENT surgical week of August 2-6th a co-ordinated effort, supported financially from WACHS, was initiated between the Kimberley Population Health Unit, Derby Hospital, Derby Aboriginal Health Service, Community Health in Derby and remote area nurses to break down some of the barriers preventing efficient and maximal utilisation of ENT and anaesthetic services whilst in town. An economic analysis of this initiative will be made in this audit.

Progress: Completed in 2010

Reference: 2010-011 - Barriers to Access and Utilization of Indigenous Eye Health Services in Australia

Researchers: Prof Hugh R Taylor, Prof David Dunt, Emma Stanford, Andrea Boudville, Colin Garlett, Robyn McNeil, Arthur Hseuh, Mitchell Anjou, Alex Ly Zhang, Helen Jordan (University of Melbourne)

Funding: Private Foundations and Donors

Project summary: Our overall aim is to “close the gap for vision” by developing evidence-based recommendations for policy change. The National Indigenous Eye Health Survey showed that although Indigenous children have better vision than mainstream children, Indigenous Australians aged 40 and above have six times the rate of blindness compared to mainstream. Ninety four per cent of their vision loss is preventable or treatable, but a third of adults have never had an eye exam. There is a significant shortfall in the provision of eye care services in outback Australia. Well co-ordinated and organised services provide a measurably better service and save money. Urban ophthalmologists and optometrists are prepared to provide these outreach services if the services are well organised.The overall aim of our current work is to develop a model of eye care for Indigenous Australians for presentation to Australian Governments. We are currently working on three key aims:

  1. Identify the specific limitations and restrictions of the current funding mechanisms that support visiting eye care services to remote areas (Medical Specialist Outreach Assistance Program-MSOAP and Visiting Optometrist Scheme-VOS).
  2. Identify key components in enhancing the pathway of care for the provision of eye services through Aboriginal Health Services.
  3. Identify the economic implications of the proposed policy changes.

Our previous research has shown the very high unmet need for eye care services amongst Indigenous Australians. In more remote areas this is due inpart to a lack of eye care services. Eye care services used by Indigenous Australians are predominantly funded by the Federal or State Governments and evidence-based models are required to influence the development and implementation of new policy. This health services evaluation will assist in this process.

Progress: Completed in 2012

Reference: 2010-012 - Culture, context and Risk: socio-cultural influences on the sexual health of Indigenous young people

Researchers: Dr KA Senior, Dr RD Chenhall, Dr T Nagel (Menzies School of Health Research); Prof MK Pitts (La Trobe University); Prof S Saggers (Curtin University); A/Pro VK Burbank (The University of Western Australia); Ms W Armstrong (Charles Darwin University); Ms H Greville (WA Sexual Health); Mr M Wentzlaff-Eggebert (SA Sexual Health Program & Policy); Dr E Moore (AMSANT); Mr S Tatipata (Danila Dilba Health Service); Mr W Beaver (Central Australian Congress Health Service); Ms J Renfree, Ms D Bridges, Ms G Grady, Ms S Matthews, Mr J Smith, Ms M Howitt, Mr A Bergs, Ms B Kelly, Ms V Schulz, Mr M McAdie, Mr A van Zyl, Mr A Castro (Northern Territory Government); Ms A Hampshire (Mission Australia); Ms M Parker (Anglicare Youth Services)

Funding: Australian Research Council

Project summary: The health of Aboriginal and Torres Strait Islander young people is a national priority and it is clear in the area of sexual health that they suffer disproportionately when compared to the non- Indigenous population. Existing interventions are not achieving the desired changes in sexual health. This project explores sexuality in the context of everyday life of Aboriginal and Torres Strait Islander young people, in order to develop interventions that are appropriate and sustainable.

Progress: Completed in 2014

Reference: 2010-013 - Promoting fit bodies, healthy eating and physical activity in Indigenous Australian men

Researchers: A/Prof Lina Ricciardelli, Prof Marita McCabe, A/Prof David Mellor, A/Prof Alexander Mussap (Deakin University)

Funding: Australian Research Council

Project summary: The aim of this study is to gain a better understanding of the risk and protective sociocultural factors that shape Indigenous men’s attitudes to health and their body, diet and physical activity, and their related behaviours . In collaboration with men from Indigenous communities the study will examine the importance of cultural identity, masculinity, intergenerational and interpersonal relationships, and sport for health. The research will be used to develop more effective strategies to promote fitness, healthy eating and positive patterns of physical activity. In order to achieve the aims of this research, the study will be undertaken in four stages, in four different locations. The first stage will involve running focus groups in each location; Stage 2 will involve semi-structured interviews; Stage 3 involves follow-up interviews; Stage 4 will involve organising and facilitating two community events in each location.

Progress: Completed in 2013

Reference: 2010-014 - Boab Health Services: Evaluation of Primary Health Care Service Delivery (Counselling, Diabetes Education, Dietetics and Podiatry) Evaluation Project

Researchers: Gail Cummins (Boab Health Services; formally Kimberley Division of General Practice)

Funding: Internal

Project summary: In 2001 the Kimberley Division of General practice, now Boab Health Services, conducted a Needs Assessment of Allied Health provision across the Kimberley region. As an outcome of this assessment More Allied Health Services (MAHS) funding was used to establish a Regional Dietetic Service and a visiting Podiatry service in the Kimberley. The demand on these individual Allied Health positions quickly indicated the need for a more comprehensive service and as additional funding opportunities became available the Primary Health Care Services auspiced by the Boab Health Services (BHS) expanded to include additional Dietetic and Podiatry positions as well as Diabetes Education and Counselling services. The Boab Health Services – Primary Health Care Team (BHS-PHCT) provides a chronic disease focused, multidisciplinary model of care to all towns in the Kimberly and to remote communities of significant size across the region. Opportunities to improve service delivery practices come from being reflective and recognising that there is science to changing behaviours, changing organisations and changing societies. The PHC professions included in the scope of this evaluation project are Counselling, Diabetes Education, Dietetics and Podiatry. The purpose of this evaluation project is to find out how aware people are of: What services are available from BHS; how the services are accessed; and once accessed, is a quality service provided and does the service meet the client’s needs. The key evaluation questions are:

  • What is the level of Community Awareness of our organisation’s Primary Health Care Services?
  • Are the Boab Health Services Primary Health Care Team’s Referral Pathways understood and working well?
  • Does the Boab Health Services Primary Health Care Team provide a Quality Service to the target population?

Progress: Completed in 2011

Reference: 2011-001 - The Mental Health Needs of WA reception prisoners

Researchers: Dr Sophie Davison, Prof Vera Morgan, Prof Daniel Rock, Prof Aleksandar Janca, A/Prof Frank Morgan, Prof Assen Jablensky (The University of Western Australia); Prof Tony Butler (University of New South Wales); Mr Michael Mitchell (Statewide Indigenous Mental Health Service); Dr Edward Petch (Statewide Forensic Mental Health Service)

Funding: WA Department of Corrective Services, WA Drug and Alcohol Office, Mental Health Commission

Project summary: Prisoner populations are characterised by disadvantage, stigmatisation, social exclusion and poor health. Studies from around the world have consistently shown that prisoners have higher rates of mental disorder than the general community, especially psychosis, major depression and antisocial personality disorder. They have high rates of substance misuse, self- harm, suicide, comorbidity of different disorders and high rates of mortality, morbidity and mental health service use after release. Their treatment needs are often not well met either in the health system or the prison system and they may revolve between the two. In the case of Indigenous offenders disadvantage is further compounded as Indigenous Australians suffer more ill-health, die at much younger ages, have lower levels of educational attainment and income, higher rates of unemployment and poorer housing conditions than the rest of the Australian populations (Grace 2010). Aboriginal people are incarcerated at alarming rates, despite the recommendations of the Royal Commission into Aboriginal Deaths in custody. WA has the highest rate of age standardised incarceration of Aboriginal people per head of population of any State with 40% of the prison population describing themselves as Aboriginal. There has been no comprehensive survey of prisoner mental health in WA to date.

The project aims to describe and quantify the nature and extent of mental disorders including alcohol and substance misuse disorders amongst all WA reception prisoners, as well as their met and unmet needs. The plan is to approach a consecutive sample of reception prisons throughout WA and interview those who consent using a standardised assessment interview that is internationally recognised and was used in the National Survey of Mental Health and Wellbeing. We will also look at their pathways into and out of prison. It is hoped that the project will provide high quality data that will assist in the planning and provision of mental health services to mentally disordered offenders both within the criminal justice system and the health system.

Progress: Ongoing

Reference: 2011-004 - Audit of birth size before and after the alcohol restriction in Fitzroy Crossing (2005-2009)

Researchers: Dr Cathy McAdam, Professor John Boulton (Kimberley Health WACHS), Ms Maureen Carter (Nindilingarri Cultural Health), Associate Professor Damien Jolley (The Alfred Centre)

Funding: Internal

Project summary: The senior women of Fitzroy Crossing achieved alcohol restrictions in October 2007 after a long and hard path of advocacy. The 12-month review undertaken by the Nulungu Centre for Indigenous Research for the WA Department of Health Office of Drug and Alcohol showed that the result of the intervention could be measured in substantial benefits to social well-being in the community, not least the amount of money spent on food. Since the alcohol restrictions were in part motivated by the high incidence of Fetal Alcohol Syndrome (now the focus of the community-wide Lilliwans survey), it is relevant to seek objectives measures of benefit for the unborn child. Birth size is the most robust measure of overall fetal growth; it is also readily available as every newborn baby is accurately measured and the results recorded in the hospital notes as well as in the WA Midwives perinatal data collection. This data also contains the maternal age and any medical complications of the pregnancy. It contains maternal smoking status but does not contain maternal intake of alcohol.

The proposal is to undertake a clinical audit of birth measures with the aim to make a comparison of birth size between babies born of mothers identifying as being from Fitzroy Crossing (postcode 6765) before and after the alcohol restrictions came into place in October 2007. The objective is to assess whether this intervention had any effect on birth weight, length and head circumference, and if there was any change in gestational age, maternal age at delivery or incidence of medical complications of pregnancy such as gestational diabetes. The audit will comprise an analysis of de-identified data from the Midwives Perinatal data collection over the period 2005-2009 to encompass the periods before and after the introduction of alcohol restrictions in October 2007.

Progress: Completed in 2013

Reference: 2011-007 - Hepatitis B in the Kimberley region in the post-vaccination era

Researchers: Dr Emma Griffiths, Dr Carole Reeve (Kimberley Population Health Unit)

Funding: Internal

Project summary: Hepatitis B is a vaccine preventable disease with the potential to cause significant morbidity and mortality in those chronically infected. The widespread introduction of hepatitis B vaccine has substantially reduced the impact of hepatitis B worldwide. Prior to the introduction of universal hepatitis B vaccination, the indigenous population of the Kimberley region was identified as a high risk group by international standards. Concerns have been raised, however, about the relative efficacy of the vaccine in remote Aboriginal and Torres Strait Islander communities, where the background risk remains much higher than the Australian average. Within the Kimberley region, case reports of chronic infection occurring despite full vaccination are known to the Kimberley Population Health Unit. Additionally, the epidemiology of hepatitis B in the Kimberley region has previously been inaccurately documented due to the inclusion of Christmas Island and Curtin detention centre detainees in summary statistics. This has led to spuriously low Aboriginal: non-Aboriginal rate ratios in published summary statistics, and impedes the evaluation of regional interventions. Surveillance of vaccine preventable diseases is an intrinsic role of the Kimberley Population Health Unit and is an essential public health service to the community. This project will aim to document the epidemiology of hepatitis B in the Kimberley region, with a focus on those fully vaccinated as children. The results will help to provide an epidemiological framework for program evaluation and identify any concerns relating to vaccine efficacy in the Kimberley region.

Progress: Completed in 2013

Reference: 2011-009 - Alive and Kicking Goals

Researchers: Prof Diego De Leo, Dr Kathy McKay (Australian Institute for Suicide Research and Prevention); Mr Joe Tighe (Alive and Kicking Goals, Men’s Outreach Service Inc

Funding: WACH

Project summary: Alive and Kicking Goals! (AKG) is a positively-framed suicide prevention peer education project which takes an innovative approach in tackling the inadequate provision of mental health services available for youth at risk in the Kimberley. Operating under the auspices of Men’s Outreach Services (MOS), AKG aims to address the growing suicide epidemic amongst Indigenous youth in the Kimberley. Using the unique vehicle of a football club to engage and educate Indigenous youth, AKG centres on skill-building, confidence and esteem-building through peer education and leadership training. The Broome Saints Football Club (BSFC) was initially used as the vehicle with which to drive this change. Recently, the BSFC, MOS, AKG and AISRAP (Australian Institute for Suicide Research and Prevention) have joined together with the aim to further develop and evaluate the AKG suicide prevention training to be delivered in the West Kimberley. The AKG training will be delivered to primary- and secondary-schools, as well as other community arenas, as requested and required by the different communities. Two different workshops will be conducted: one for those aged 16+ years and those aged 10-15 years. A positively-framed DVD provides the foundation for both workshops.

Progress: Completed in 2014

Reference: 2011-011 - Social and Cultural Resilience and Emotional Well-being of Aboriginal Mothers in Prison (SCREAM)

Researchers: Elizabeth Sullivan, Juanita Sherwood, Tony Butler, Eileen Baldry (University of New South Wales); Jocelyn Jones, Mandy Wilson (National Drug Research Institute); Marisa Gilles (Western Australian Health Department), Michael Levy (Australian National University); Devon Indigenous, Jane Walker (Centre for Health Research in Criminal Justice

Funding: NHMRC

Project summary: Aboriginal and Torres Strait Islander adults are imprisoned 14-19 times more frequently than non-Indigenous people in Australia. This is one of the highest rates of Indigenous incarceration among the OECD countries. The number of Aboriginal women being imprisoned is also increasing each year, with a nine per cent rise between June 2009 and June 2010 alone; this is compared to three per cent among non-Indigenous women and two per cent among Indigenous men. This makes Aboriginal and Torres Strait Islander women the fastest growing sub-group among the prisoner population; particularly in Western Australia and New South Wales. Of these women approximately 80 percent are mothers.

SCREAM is funded through the National Health and Medical Research Council and aimed at understanding the health and treatment needs of Aboriginal mothers in prison in Western Australia and New South Wales. Taking a mixed methods approach and involving a broad range of stakeholders throughout the research process the project aims to:

  • Describe the health of Aboriginal mothers in prison, with a focus on social and emotional wellbeing;
  • Investigate availability and equity of access to culturally safe health care in prison for Aboriginal women;
  • Identify the key attributes of culturally safe models of health care for Aboriginal women in prison;
  • Identify pathways for the transition of culturally safe health care into the community so that health gains are maximised on release from prison; and,
  • Build capacity among Aboriginal researchers, Aboriginal community controlled health services and relevant community organisations.

This research plan involves Aboriginal women and a broad range of other stakeholders in identifying practical steps to reduce health inequalities between incarcerated Aboriginal mothers and female carers and those in the community. The immediate outcomes of the completed study will include:

  • Specific recommendations for models of care for Aboriginal women in prison;
  • Increased capacity among Aboriginal female researchers in the field of public health and prison health; and,
  • Recommendations for professional development and skills training among health and correctional workers in Australian prisons.

Opportunities for early intervention to prevent future offending behaviour in children will be identified, with the research providing a platform for policy and practice change.

Progress: Ongoing

Reference: 2011-013 - Planning, Implementation and Effectiveness (PIE) in Aboriginal and Torres Strait Islander Aboriginal and Torres Strait Islander Health Policy Reform

Researchers: A/Prof Margaret Kelaher, Dr Mark Lock, Ms Hana Sabanovic (University of Melbourne)

Funding: Lowitja Institute and Australian Research Council

Project summary: A great deal of time and resources is devoted to planning processes in Aboriginal and Torres Strait Islander health but despite this very little is known about the relationship between planning processes and implementation. The importance of engaging Aboriginal and Torres Strait Islander people in the development of policy and planning has been recognised in the National Indigenous Reform Agreement (NIRA) and the Aboriginal and Torres Strait Islander Health National Partnership Agreements (HNPAs). Despite this there are no benchmarks that define appropriate participation or planning approaches within the agreements. Developing this area of knowledge is critical given that a lack of consideration of community values is both a major limitation in health policy analysis and a major contributor to failed policy reform both in Australia and internationally.

This project builds on work we have conducted examining the planning processes underlying the implementation of the first part of the HNPA. This work focussed on understanding the structure of and relationships between forums/committees involved in implementing the HNPA. It reviewed the plans and used social network analysis to understand the links between forums/committees in terms of membership and patterns of communication. In this project we aim to develop the evidence base defining best practice in the engagement of Aboriginal and Torres Strait Islander people in policy and practice. The project will build on the approaches of the first project by using social network analysis to understand the relationship between organisations involved in planning at different levels and the effects of this on program implementation. It will particularly focus on State and Territory planning committees at state/territory level and at regional level. These committees provide a critical link in the implementation of agreements with COAG and regional planning processes. This will enable a multilevel approach that ensures that the different ways that Aboriginal and Torres Strait Islander participation is actualised at different levels of government can be taken into account.

Progress: Completed in 2014

Reference: 2011-014 - Investigation into cause of mortality of members on Rheumatic Heart Disease control program for period 2000-2010

Researchers: Dr Sarah Woodland, Dr Carole Reeve (Kimberley Population Health Unit)

Funding: Internal

Project summary: Aim: to determine the causes of mortality in patients with RHD (Rheumatic heart Disease) in the Kimberley

The research project is based on the observation that many of the members of the Rheumatic Heart disease register known to have died have a young age of death. Other investigations have shown that ARF and RHD not only affects but kills Aboriginal people in their most productive years. The project will be conducted via systematic review of death certificates, medical records and public records to ascertain the cause of death of patients known to have Rheumatic Heart Disease who were on the RHD Register. This information will then be used to assess the impact of RHD on mortality in the Kimberley region.

Progress: Completed in 2013

Reference: 2011-015 - Improvements in antenatal care for remote Indigenous Australians using a case-based midwifery model of care

Researchers: Dr Sally Banfield, Dr Carole Reeve (Kimberley Population Health Unit)
Funding: Internal
Project summary: Delivery of high-standard antenatal care to Indigenous Australians is essential to improving the health outcomes for both mother and newborn child. If service delivery is effective, it can strengthen positive bonds between the health care providers and the individual.

Unacceptably high rates of preterm births, low birthweight babies and perinatal mortality fall to the Australian Indigenous population. Research has shown poor obstetric outcomes are related to poor antenatal attendance, maternal malnutrition and high rates of tobacco and alcohol use.
Traditionally, the Kimberley region has provided antenatal care with community and hospital based midwives, GPs, and hospital based medical staff.

This project is considered to be an audit of antenatal care and its health outcomes prior to and during the intervention period of a case-based midwifery model of care. This intervention model involved a regionally-located midwife following women throughout the antenatal period, ensuring continuity of care in a culturally safe environment.

Progress: Completed in 2012

Reference: 2011-016 - National Aboriginal and Torres Strait Islander Health Measures Survey

Researchers: Dr Paul Jelfs, Juanita Pettit (Australian Bureau of Statistics)

Funding:Commonwealth Department of Health and Ageing

Project summary: The Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS) is a new Australian Bureau of Statistics information collection, funded by the ABS, Commonwealth Department of Health and Ageing (DoHA), and the National Heart Foundation of Australia. A significant component of the Australian Aboriginal and Torres Strait Islander Health Survey is the National Aboriginal and Torres Strait Islander Health Measures Survey (NATSIHMS) – a collection of biomedical information from Aboriginal and Torres Strait Islander respondents.

The NATSIHMS aims to measure markers for chronic disease and nutrition status derived from tests on blood and urine biospecimens (samples) from Aboriginal and Torres Strait Islander respondents from both remote and non-remote localities. It is important to note that participation in this component of the survey is voluntary and requires explicit consent by the respondent.

The resultant information from this survey will establish population benchmarks for these tests; provide information to assess health risks for population groups and to provide a platform for further research into health patterns. This will be achieved by combining the results of objective biomedical tests with self-reported survey-based results. With a number of these health risk factors being collectively responsible for shortening the lives of so many Aboriginal and Torres Strait Islander Australians, comparisons with the general population* will support assessment of progress in Closing the Gap in Aboriginal and Torres Strait Islander health outcomes.
There are no specific hypotheses established for testing in this survey, rather it is an establishment of a public health data base of objective measures of chronic disease and nutrition status indicators for descriptive purposes and creating an opportunity for a wide range of data users to access the data under controlled mechanisms to explore Aboriginal and Torres Strait Islander health issues. These further users of the data may have specific hypotheses that will be tested.

*ABS is currently conducting a biomedical survey in the general population as part of the Australian Health Survey. This biomedical component is known as the National Health Measures Survey (NHMS).

Progress: Completed in 2014

Reference: 2011-018 - Prev-ix_Combo

Researchers: A/Prof Amanda Leach, Prof Edward (Kim) Mulholland, Dr Heidi Smith-Vaughan, A/Prof Sue Skull, A/Prof Ross Andrews,Prof Jonathon Carapetis, Joseph McDonnell, Dr Vicki Krause, A/Prof Peter Morris (Menzies School of Health Research); Prof Mathu Santoshum (Johns Hopkins Bloomberg School of Population Health, USA); A/Prof Paul Torzillo (RPA Hospita); A/Prof Ngaire Brown (Poche Centre for Indigenous Health); Prof Peter McIntyre (Children’s Hospital Westmead, NSW; Anne Balloch (Murdoch Children’s Research Centre)

Funding: NHMRC

Project summary: A randomised controlled trial of pneumococcal conjugate vaccines Synflorix and Prevenar 13 in sequence or alone in high-risk Indigenous infants (PREV_IX_COMBO): immunogencity, carriage and otitis media outcomes. The combined schedule has the potential to provide protection from multiple bacterial pathogens of high significance. Internationally standardised correlates of vaccine protection, and clinical outcomes, will provide convincing evidence for vaccine policy here and worldwide.

Progress: Ongoing

Reference: 2011-019 - The ‘Clinical Guidelines for the Physical Care of Mental Health Consumers’ Multi-site Service Evaluation Pilot Project

Researchers: Dr Jonathan Laugharne, Susanne Stanley (The University of Western Australia)

Funding: Mental Health Commission WA

Project summary: In 2001, Lawrence, Holman and Jablensky released the Duty to Care report, revealing a range of physical disorders in people with a mental illness at markedly elevated rates when compared to the general population. The Who is Your GP report (HealthRight Advisory Group, WA Office of Mental Health, 2004) followed soon after recommending the development of clinical guidelines and monitoring protocols to improve the physical health of mental health consumers. In 2009, the Department of Health WA commissioned the Community, Culture and Mental Health Unit (UWA) to review the international literature and develop such guidelines. The Clinical Guidelines for the Physical Health Screening of Mental Health Consumers package was developed, and can be used and/or adapted for inpatient, outpatient, or community care situations. In essence, the Clinical Guidelines assessment package provides an overall, individualised, evidence-based evaluation of each consumer’s physical health status, where initial assessment results are used as a baseline from which to monitor ongoing health status. The integration of the Clinical Guidelines for the Physical Health Screening of Mental Health Consumers into Standard Mental Health Clinical Documentation places WA at the forefront of consumer physical health assessment.

In order to ease the introduction of these directives, the Mental Health Commission has provided funding to conduct a pilot service evaluation across the state to assess any issues that might arise during the implementation of mandatory physical health assessment and ongoing monitoring of mental health patients. The Clinical Guidelines physical assessment package will be provided to different services in different contexts (i.e. rural settings, inpatient, community outpatients, forensic psychiatry, and private practice) across WA. To evaluate the services, we will be conducting an audit of the patient screening forms and using a qualitative questionnaire to investigate potential difficulties for services. It is likely that a large number of participants in the evaluation of the Kimberley region of WA will be of Aboriginal or Torres Strait Islander decent. As poor physical health is a major issue for this population of people, we see enormous benefit in their inclusion in the evaluation. The data collected will also be analysed and possible publications will ensue to promote better physical health for mental health patients.

Progress: Completed in 2013

Reference: 2011-020 - Translating primary health care policy into service delivery

Researchers: Dr Carole Reeve, Tim O’Brien, Monica Frain, Dr Peta Williams, Dr David Reeve (Kimberley Population Health Unit); Ms Maureen Carter (Nindilingarri Cultural Health Services)

Funding: DoH

Project summary: This project aims to determine the effectiveness of moving from an acute focused hospital-based care system to a population based primary health service model of service delivery in small integrated hospitals in remote Aboriginal communities in the Kimberley.

Fitzroy Crossing is in the process of moving from being an acute hospital based model to community primary health based service provision. This has resulted in a demonstrated increase in occasions of service, improved chronic disease screening and outcome measures without a significant increase in staffing levels by using staffing more efficiently. We would like to examine this model of care in further detail and demonstrate additional savings and/or cost efficiencies in extending this primary health care model. A key enabler for this was the formal partnership developed with Nindilingarri Cultural Health Services.

Progress: Completed in 2013

Reference: 2011-021 - Pathways to Care

Researchers: Prof Diego De Leo, Dr Kathy McKay Eeva-Katri Kumpula (Australian Institute for Suicide Research and Prevention, Griffith University

Funding: Commonwealth Department of Health and Ageing

Project summary: The Pathways to Care Project is conducted by the Australian Institute for Suicide Research and Prevention on behalf of the Commonwealth Department of Health and Ageing (DoHA) for the Australian Suicide Prevention Advisory Council (ASPAC). The project seeks to examine the mechanisms in place across Australia to respond to and provide care to people at imminent risk of suicide. The type of support a person at imminent risk of suicide receives can depend on how they come into contact with the support system but may also reflect differences in state- and territory-level legislation and the availability of resources in local areas. Consequently, ASPAC and DoHA are seeking to gain a better understanding of the ways in which people at imminent risk of suicide access these support systems.

Progress: Completed in 2013

Reference: 2011-022 - Australian and New Zealand SNAPSHOT ACS

Researchers: Dr Tony Mylius (WA Country Health); Dr Jamie Rankin (Royal Perth Hospital); Dr Michelle Ammerer (Sir Charles Gairdner Hospital); Dr Alan Whelan (Fremantle Hospital); Dr Siang Ung (Swan District Hospital); Dr Elizabeth Patterson (Rockingham District Hospital); Dr David Playford (Armadale Hospital); Dr Andrei Catanchin (Joondalup Health Campus); Dr Mark Hands (St John of God Subiaco)

Funding: Snapshot ACS has secured communication funds for teleconferencing from the Cardiac Society of Australia and New Zealand. High-level in kind project officer support has been provided by a majority of state Health and Clincial Networks, including the WA Department of Health.

Project summary: Snapshot ACS is a prospective registry which is designed to evaluate the existing patterns of care for patients who are admitted to hospital with an ACS in order to improve the quality of care. The project has recently received endorsement from the Australian Commission on Safety and Quality in Healthcare.

More than 400 centres that treat patients with ACS in Australia and New Zealand will be asked to participate and the researchers expect to enroll approximately 4,000 patients over a 2 week period. The main objective of the registry is to provide a greater understanding of the management and health outcomes of patients across the full breadth of hospitals in both countries.

Information on the clinical characteristics, the in-hospital investigations and management of patients will be collected. This will be compared to guidelines for recommended practice. This data will inform future strategies to improve ACS care in Australia and New Zealand.

Progress: Did not commence in the Kimberley

Reference: 2011-023 - Surgery for the Treatment of Otitis Media in Indigenous Children

Researchers: Prof Stephen O’Leary (Royal Victorian Eye & Ear Hospital); Prof Harvey Coates (PMH for Children); A/Prof Kelvin Kong (Newcastle); A/Prof Peter Morris (Royal Darwin Hospital); A/Prof Chris Perry (Royal Children’s Hospital Brisbane); Ms Adrienne Kirby (University of Sydney

Funding: NHMRC

Project summary: Ear infection (otitis media) is a major problem amongst children living in remote Australian communities. Medical treatment often fails, and ear nose and throat surgeons are called upon to provide surgical care. This clinical trial will provide surgeons with evidence so that they can recommend the best possible operation for children living in desert and tropical regions, most of whom are indigenous, to improve hearing and reduce the prevalence of ear infection and discharging ears.

This will be a multi-centre randomised trial across remote areas of NT & WA. It will assess the effects of two surgical interventions in the management of otitis media. Aboriginal and Torres Strait Islander children, between the ages of 3-10 years will be randomized into 3 groups:

  1. adenoidectomy with ventilation tubes (VTA)
  2. adenoidectomy with myringotomy only (MA)
  3. medical treatment with the offer of surgery after 12 months if clinically indicated.

The children will be followed up for 12 months following surgery. This will be by monthly phone calls to the family to ask about the child’s ear health and a visit to the community after 12 months to test hearing and review ear and nasal swabs. It is expected that by the end of this period the ventilation tube will have dropped out (usually after 3-6 months), and that the otitis media will likely have recurred if were to do so.

The primary aim is to see a reduction in the prevalence of otitis media. Secondary aims include measuring hearing impairment, the prevalence of aural discharge, aural perforation, and the effect of treatment on nasal colonisation with pathogenic bacteria. The study will test whether there is an advantage of VTA or MA over medical therapy in controlling otitis media.

Progress: Ongoing

Reference: 2012-001 - An Audit of Cervical Screening and Follow up in the Kimberley Region

Researchers:Dr. Philippa Chidgzey, Dr. Carole Reeve (Kimberley Population Health Unit); Dr. Lauren Turner, Dr. David Atkinson, Dr. Melissa Roberts (Kimberley Aboriginal Medical Services Council); Dr. Wendy Hughes (Broome Hospital – WA Country Health Service); Dr. Rebekah Adams (Broome Regional Aboriginal Medical Service)

Funding:

Project summary:Cervical cancer and cervical abnormalities represent a significant health concern for Australia’s Aboriginal and Torres Strait Islander female population, especially in rural and remote locations. Service delivery of pap smears for Aboriginal women may be limited for many reasons in this region, including cultural appropriateness of screening delivery and follow up, screening promotion, the transient nature of many people in the region and also by the limited number of pap smear providers in the region. There are currently two specialist gynaecologists in the Kimberley Region available to perform definitive diagnostic procedures on women with screen detected abnormalities. Currently, each health service site follows up women with abnormalities within each locality and refers for gynaecology services when required.

This project in essence is an audit that aims to identify all women aged 18 to 69 years within the region to ascertain their pap smear screening and follow up. The results will help to provide an epidemiological framework for cervical screening program evaluation and identify any concerns relating to women’s health service delivery in the Kimberley region. With this information we aim to identify any gaps and make recommendations for improvements in electronic communication systems between health service sites and organisations in the Kimberley region in relation to cervical health.

Progress: Ongoing

Reference: 2012-002 - Use of dental services and child oral health survey. The Australian National Child Oral Health Study

Researchers: Professor A John Spencer, Dr. Loc Do, Professor Kaye Roberts-Thomson (Adelaide University)

Funding: NHMRC

Project summary: Researchers from the Australian Research Centre for Population Oral Health (ARCPOH) in conjunction with the West Australian Dental Health Service are participating in a National Child Oral Health Survey. The aims are to investigate the impact of dental disease in child populations in Australia. The purpose of the study is to inform policy makers and dental service providers at the national and state/territory level in shaping effective dental service delivery so as to improve child oral health. The project will provide a combination of an oral epidemiological examination and a social survey of dental use, service-mix received, and other determinants of oral health in line with current epidemiological studies and to link these data with the underlying variation in dental service delivery systems.

Progress: Ongoing

Reference: 2012-003 - The 'Test, Treat ANd GO' (TTANGO) Trial

Researchers: Dr Rebecca Guy, Mr James Ward, Professor John Kaldor, Professor Basil Donovan, Dr David Regan, A/Prof David Wilson, Dr Handan Wand, Dr Louise Causer (The Kirby Institute, University of New South Wales); Dr David Whiley (Royal Children’s Hospital, Brisbane); A/Prof Sepehr Tabrizi (The Royal Women’s Hospital, Melbourne); Prof Christopher Fairley (University of Melbourne); A/Prof Mark Shephard (Flinders University); A/Prof David Anderson, Ms Lisa Natoli (Burnet Institute); Ms Belinda Hengel (Apunipima Care York Health Council)

Funding: NHMRC

Project summary: The study design is a cross-over cluster randomised controlled trial (RCT) in remote Aboriginal communities. Twelve health services (6 in QLD and 6 in WA) will be will be invited to participate in the trial if they meet the following inclusion criteria:

  • Located in communities classified as remote or very remote by ABS
  • At least 10% of CT and NG tests done are positive in 16-29 years olds in a year
  • Annually offer CT and NG testing to a minimum of 150 people aged 16-29 years (or services have the capacity to do so);
  • Agree to be randomly assigned in one year out of two to the “POC” phase;
  • Have an electronic patient management system; and
  • Have the staff and resource capacity to fulfil protocol requirements.

Each health service will undertake the clinical management of chlamydia and gonorrhoea under two different modalities for one year each, in a randomly assigned order. In the first year, six of the health services will be randomly assigned to manage these infections under current diagnostic guidelines (“standard practice” phase), and the other six will supplement current diagnostic guidelines with POC testing (“POC” phase), such that diagnosis is made and subsequent treatment for those with positive POC tests is offered at the time of initial consultation. In the second year, the health services will cross over to the opposite management modality.

Progress: Ongoing

Reference: 2012-004 - Audit of trichiasis in the Kimberley 2008-2009 *Now to assess data from 2010-2012

Researchers: Dr Amanda Thomas, Dr Carole Reeve (Kimberley Population Health Unit)

Funding:

Project summary: Trachoma remains a significant public health issue in the Kimberley region of Western Australia, remaining endemic in the Aboriginal population. Trichiasis is a late complication of trachoma and is a preventable cause of blindness. Previous studies have documented rates of trichiasis in this region to be between 3% and 10%. The rate of trichiasis is significant to guide us as to whether trachoma is still causing blindness in the Kimberley.

In 2008 and 2009, community health nurses were trained to recognise signs of trichiasis, and screening was offered to any Aboriginal person over the age of 40 who was presenting for influenza vaccination (or annual adult health check, which was added in 2009).

Ethics was granted for an evaluation of this program in 2008, we would like to extend the study period to include the subsequent years in this retrospective audit.

The extension of this study aims to review data from screening carried out in 2009, 2010, 2011 and 2012 to determine the best screening method for trichiasis in the Kimberley.

Progress: Did not commence

Reference: 2012-005 - Eye Health Awareness and Education for Diabetic Indigenous Australians in the Kimberley

Researchers: Joos Meyer, Angus Turner (COVS, UWA)

Funding: Lions Eye Institute

Project summary: This project’s central aim is to evaluate the effectiveness of a new educational resource in the form of a short animated video clip, being implemented for patient education on diabetic retinopathy screening. The video has been specifically designed with the Australian Indigenous population in mind. It will be used as part of the screening routine around Western Australia. The study will be a qualitative study using a short questionnaire before and after the video to evaluate patient knowledge, satisfaction with the screening service and motivation for future screening.

Participants will be diabetic patients of an Indigenous Australian background who present for their routine annual diabetic retinopathy screening photograph. They have been selected as the purpose of the video is to educate this population on diabetic retinopathy and the justification for screening.

Progress: Completed in 2012

Reference: 2012-006 - Cultural Continuity and Change: Indigenous Solutions to Mental Health Issues

Researchers: Professor Pat Dudgeon (School of Indigenous Studies, UWA)

Funding:

Project summary: The overall aim of this project is to develop Aboriginal understandings for improved social and emotional wellbeing in the Aboriginal communities of Broome and Perth. Concepts of cultural continuity (a strong sense and valuing of one’s identity) and social and emotional wellbeing will be compared and validated by the Aboriginal communities of Perth and Broome. This will inform programs, services and policy to better meet the mental health needs of Indigenous people. Specific aims are:

  • To undertake participatory action research with the Aboriginal communities of Perth and Broome to develop knowledge’s about mental health/social and emotional wellbeing from an Aboriginal perspective
  • To compare concepts of cultural continuity and social and emotional wellbeing to identify similarities and differences
  • To establish an Indigenous Reference Group of relevant Indigenous and non- Indigenous people from Perth and Broome to oversee the research project and to determine key concepts of the research
  • To build relationships and develop collaborations with key individuals and organisations providing mental health services to the Aboriginal community in Perth and Broome
  • To undertake interviews, focus groups and meetings with Aboriginal community members about understandings of social and emotion wellbeing and to identify how these translate in policy, services and programs
  • To highlight a gendered approach where two markers of cultural continuity: culture and women in governance is specifically considered
  • To provide an empirical evidence base of effective methods that Aboriginal people from urban, regional and remote areas use to manage psychological and emotional distress.

Progress: Ongoing

Reference: 2012-007 - Improving the health of Indigenous and non-Indigenous ex-prisoners: A multi-jurisdictional, mixed-methods study

Researchers: Prof David Preen, Asst/Prof Diane Arnold-Reed (University of WA); A/Prof Stuart Kinner, Prof Robert Power(Burnet Institute); Prof Nick Lennox (The University of Queensland); Prof Tony Butler (The Kirby Institute, University of NSW); Ms Coralie Ober, Dr Robert Ware (University of Queensland)

Funding: NHMRC

Project summary: This study will focus on health outcomes and health service utilisation among adult ex-prisoners in two states Queensland (QLD) & Western Australia (WA) that hold 44% of Australia’s Indigenous prisoners. Using a combination of quantitative and qualitative interviews, review of health records and prospective record linkage, we will identify the key health needs of this highly marginalised group and recommend targets for public health intervention and policy reform to reduce the burden of disease and improve physical health, mental health and criminal justice outcomes.

Progress: Did not comence in the Kimberley

Reference: 2012-008 - The Picture Talk Project: Developing Culturally Appropriate Communication Methods for Seeking Consent for Research with Aboriginal Communities of the Fitzroy Valley

Researchers: Professor Elizabeth Elliott, Dr Emily Fitzpatrick, Dr Alexandra Martiniuk (The George Institute for Global Health); Ms Heather D’Antoine (Menzies School of Health Research); Ms June Oscar (Marninwarntikura Women’s Resource Centre); Ms Maureen Carter (Nindilingarri Cultural Health Services)

Funding:

Project summary: Aboriginal leaders in the Fitzroy Valley (Kimberly, WA) initiated a partnership between Marninwarntikura Women’s Resource Centre and Nindilingarri Cultural Health Services (Fitzroy Crossing); The University of Sydney Medical School and The George Institute for Global Health to estimate Fetal Alcohol Spectrum Disorders (FASD) prevalence (The Lililwan Project). There is strong community support for the Project.

Stage 2 of The Lililwan Project involved FASD diagnostic assessments of children born 2002-2003 and residing in Fitzroy Valley. Flip charts were produced using photographs of people known in Fitzroy Crossing to help seek informed consent for Stage 2 in 2011. These were used in conjunction with participant information statement and consent forms approved previously by Human Research Ethics Committees (HREC) by The Lililwan Project research team, including Community Navigators – local Aboriginal people employed to assist with language and cultural barriers.

The Picture Talk Project will examine the preference of methods used for seeking community and individual consent for research by conducting interviews with Aboriginal community leaders and focus groups with Aboriginal people.

This study is unique in that its primary focus is on the concept of consent for research with Aboriginal Australians. Few studies have evaluated the consent process. The Picture Talk Project is collaborative, involving local Aboriginal leaders and experienced Aboriginal researchers as chief investigators on the project. The Picture Talk Project stems from The Lililwan Project, which was led by local Aboriginal communities and approved by HREC.

In this project we will use scientifically rigorous qualitative research methods, including structured interviews and focus groups adapted to ensure cultural safety by Aboriginal investigators to provide unique, first-hand, perspectives from Aboriginal people of the Fitzroy Valley on the process for seeking consent for research. This project aims to provide feedback about The Lililwan Project and help to inform how future research might be conducted.

Progress: Ongoing

Reference: 2012-009 - Validity of the iPhone in capturing slit-lamp views of the eye for Teleophthalmology

Researchers: Dr Angus Turner, Karim Johnson (Centre for Ophthalmological and Visual Sciences, Lions Eye Institute)

Funding: Eye Surgery Foundation

Project summary: People in rural areas experience greater levels of ill health and lower access to health services than metropolitan residents. Telehealth offers an alternative approach to improve both the quality and access to healthcare irrespective of location. Currently a Telehealth service for eye care, Teleophthalmology, operates in the Kimberley region of Western Australia. Image capture and transfer are integral components of Teleophthalmology. With recent advances in technology there has been a trend to using smartphones to capture images of the eye.

The aim of this study is to assess the validity of using an iPhone in digital imaging of slit-lamp views of the eye for use in Teleophthalmology consultations. If an iPhone can reliably be used, it will provide an alternative to more expensive digital camera slit-lamps, especially for those areas with limited funding for such a device. This has the potential to affect imaging practices for Teleophthalmology services nationally and internationally.

Progress: Did not comence

Reference: 2012-010 - Audit of ear health outcomes in the Fitzroy Valley

Researchers: Dr Amanda Thomas, Dr Carole Reeve (Kimberley Population Health Unit)

Funding:

Project summary: Ear, Nose and Throat (ENT) conditions represent a significant health concern for Australia’s Indigenous population, especially in rural and remote areas. Service provision of ENT specialists in the Kimberley region is limited for multiple reasons, and every effort must be made to maximise specialist time when they are available in the region.

In 2010, an audit was performed on ENT referral letters to determine what clinical information was provided to the visiting ENT surgeons and what initial management plan had been implemented. It was found that limited information was conveyed to the specialists, so despite long waiting times, it was not possible to triage referred cases(1). Following this study, an electronic referral template was implemented to ensure adequate referral information was conveyed. Telehealth sessions were also conducted to minimise waiting times for scheduled visits.

This audit aims to review the new referral process, the wait-list times for specialist review and surgery, and again review the management of each individual case, now that these new processes have been implemented.

Progress: Completed in 2013

Reference: 2012-013 - Evaluation of the HITnet machines in Aboriginal Medical Services

Researchers: Sharon Clews, Benny Sullivan (Department of Health)

Funding:

Project summary: The HITnet machines have been developed by HITnet, University of Queensland (now a private social enterprise separate to the University) to facilitate communication with hard-to-reach communities (www.hitnet.com.au).

To supply regional and remote locations with interactive sexual health information, the Sexual Health and Blood-borne Virus Program [SHBBVP], Department of Health WA [WA Health], purchased 10 HITnet machines for Aboriginal Health/Medical Services [AMSs] that expressed interest in the technology: Balgo, Broome, Geraldton, Halls Creek, Jigalong, Kalgoorlie, Roebourne, Wiluna, Kununurra, and Kiwirrkura.

As well as purchasing and providing the machines, the SHBBVP continues to provide ongoing maintenance. As a result, the SHBBVP is evaluating the use and relevance of these machines in the AMSs of which they are located.

This evaluation will serve to inform the future provision of the HITnet machines, as well as to identify other effective options at locations where the machines are not being used effectively. The evaluation will also inform the future development of content for the HITnet machines.

Progress: Completed in 2013. Final evaluation report available from: http://www.public.health.wa.gov.au/3/466/2/reports_and_publications.pm

Reference: 2012-014 - Gonorrhoea treatment in the Kimberley

Researchers: Dr Jake Parker, Dr Carole Reeve (Kimberley Public Health Unit)

Funding:

Project summary: Gonorrhoea is a potentially preventable sexually transmitted infection which, if remains untreated, can lead to unnecessary surgery, chronic pain syndromes, increased rates of life-threatening ectopic pregnancy, and reduced fertility. The Kimberley region has some of the highest rates of gonorrhoea in Australia and, although had remained stable in the 10 years to 2008, has become more irregular in the past 4 years. Whilst gonorrhoea treatment best-practice guidelines have been developed, it has been shown that adherence is intermittent. Several barriers to treatment have been postulated, including the timely access to a treatment order.

This study will investigate the drivers which influence the rate of gonorrhoea infections in the Kimberley. In addition, it will assess if the provision of a “doctor’s treatment order” at the time of notification will improve adherence to best practice guidelines. Data will be sourced from routine clinical documentation or health staff. Results will be compared to a retrospective audit of where no “doctor’s treatment order” was provided.

Progress: Completed in 2013

Reference: 2012-015 - East Kimberley Homelessness Project

Researchers: Rachelle Irving, Giancarlo Mazzella (EKCDEP)

Funding: FaHCSIA

Project summary: The East Kimberley Homelessness Project will define the nature and extent of homelessness in the East Kimberley region, with a view to informing the East Kimberley Homelessness Plan. This Plan is part of the larger Implementation Plan as part of the National Partnership Agreement on Homelessness between the Commonwealth of Australia and Western Australia. The project is being managed and driven by staff appointed to East Kimberley Community Development Employment Program through funding from the Department of Families, Housing, Community Services and Indigenous Affairs.

Given that the majority of people who are homeless or at risk of homelessness in the East Kimberley are Aboriginal, the definition for homelessness will incorporate that developed by Keys Young (1998) which goes beyond the traditionally used primary, secondary and tertiary homelessness. The definition to be used in this project is Indigenous specific and will include those who are affected by spiritual homelessness; overcrowding; relocation and transient homelessness; escaping from unsafe and unstable homes; and lack of access to stable shelter.

The research stage will involve consultation with NGOs, government department staff and community members about the current issues and barriers facing people living in the East Kimberley who are homeless or at-risk of homelessness. The surveys for the NGOs and government representatives are currently in the field and it is already clear that homelessness is a major issue in the East Kimberley, with overcrowding and lack of housing the major themes. The most important part of the project will be consultation with the community to ensure that the views and experiences of the people most affected by homelessness are driving the future East Kimberley Homelessness Plan. The community interviews will be conducted on country talking to people about their concerns and thoughts about solutions to the problems regarding overcrowding, housing and homelessness.

The Project will culminate in a number of recommendations which will be based on the research findings. It is likely that some of these recommendations will be acted upon within the project period, prior to 30 June 2012 while others will require considerable funding and system level changes into the future.

Progress: Completed in 2013

Reference: 2012-015 - East Kimberley Homelessness Project

Researchers: Rachelle Irving, Giancarlo Mazzella (EKCDEP)

Funding: FaHCSIA

Project summary: The East Kimberley Homelessness Project will define the nature and extent of homelessness in the East Kimberley region, with a view to informing the East Kimberley Homelessness Plan. This Plan is part of the larger Implementation Plan as part of the National Partnership Agreement on Homelessness between the Commonwealth of Australia and Western Australia. The project is being managed and driven by staff appointed to East Kimberley Community Development Employment Program through funding from the Department of Families, Housing, Community Services and Indigenous Affairs.

Given that the majority of people who are homeless or at risk of homelessness in the East Kimberley are Aboriginal, the definition for homelessness will incorporate that developed by Keys Young (1998) which goes beyond the traditionally used primary, secondary and tertiary homelessness. The definition to be used in this project is Indigenous specific and will include those who are affected by spiritual homelessness; overcrowding; relocation and transient homelessness; escaping from unsafe and unstable homes; and lack of access to stable shelter.

The research stage will involve consultation with NGOs, government department staff and community members about the current issues and barriers facing people living in the East Kimberley who are homeless or at-risk of homelessness. The surveys for the NGOs and government representatives are currently in the field and it is already clear that homelessness is a major issue in the East Kimberley, with overcrowding and lack of housing the major themes. The most important part of the project will be consultation with the community to ensure that the views and experiences of the people most affected by homelessness are driving the future East Kimberley Homelessness Plan. The community interviews will be conducted on country talking to people about their concerns and thoughts about solutions to the problems regarding overcrowding, housing and homelessness.

The Project will culminate in a number of recommendations which will be based on the research findings. It is likely that some of these recommendations will be acted upon within the project period, prior to 30 June 2012 while others will require considerable funding and system level changes into the future.

Progress: Completed in 2013

Reference: 2012-016 - Alive & Kicking Goals! Suicide Prevention App Component

Researchers: Professor Helen Christensen, Dr Fiona Shand, Rebecca Ridani (Black Dog Institute); Dr Kathryn McKay (University of New England); Joe Tighe, Joshua Sibosado, Craig Sampi (Alive and Kicking Goals)

Funding: Australian Government Department of Health and Ageing

Project summary:Alive & Kicking Goals! (AKG) is a suicide prevention initiative currently in place in the Kimberley. The Black Dog Institute is partnering with AKG in order to bolster the provision of mental health services for at risk youth within the region. The long-term aim of this project is to develop a mobile phone suicide prevention application (app) that provides anonymous and immediate support for at risk youth. However, the preliminary stage of this project (and which this application pertains to) involves running focus groups to garner input from Indigenous youth on what would make for a good app. As such, we are seeking to find out from youth how they cope with problems in their daily lives, what part technology can play in helping them to better cope with such challenges, what mobile phone apps appeal to them and why, and what features they would want from an app that is designed to assist them with the betterment of their mental health. Although the app is aimed at individuals who are having suicidal thoughts, but are not yet in crisis, there will nevertheless be a ‘crisis button’ to help individuals or friends/family identify who is at risk and how to respond.

Progress: Completed in 2013

Reference: 2012-017 - Health outcomes associated with school gardens and nutrition programs in Noonkanbah

Researchers: Dr Jake Parker, Dr Carole Reeve (Kimberley Public Health Unit)

Funding:

Project summary: Nutrition-related illness remains a significant contributor to preventable disease in Indigenous Australians. It has been shown that many Indigenous people don’t consume the daily recommended amount of fruit and vegetables. Eating behaviours in remote areas such as the Kimberley are influenced by a myriad of factors including food security, where access and availability plays an important role. Nutrient deficiencies, particularly during childhood, are associated with iron-deficiency anaemia, middle ear disease and skin disease. These conditions can result in long-term ill health such as hearing loss, growth delay, learning difficulties, and rheumatic heart disease and others.

In response, many initiatives have sought to improve the nutrient intake of people living in remote communities. Many of these have sourced and imported fruit and vegetables from other regions. The EON foundation has run their ‘Edible Gardens’ and ‘Healthy Eating’ programs in several Kimberley communities which aims to establish a community-run school-based garden and run nutrition education programs for school aged children. They have worked with the Noonkanbah community with these two programs since 2009.

This data review aims to retrospectively show any health impacts of nutrition-related diseases in 5-9 year old children following the implementation of these two programs. It will utilise data regarding the diagnoses of anaemia, middle ear disease and skin infections from Communicare (community electronic health record) from 2009 to 2012. Trends will be charted against key milestones in the nutrition programs as well as identified potential confounders.

Progress: Completed

Reference: 2012-018 - TASK - Toward A Smoke Free Kimberley

Researchers: Local Researchers (OVAHS, DAHS); Tara Page, Moana Tane (KAMSC)

Funding:

Project summary: Almost half of Aboriginal people smoke and it represents the biggest single health risk to the community. Smoking is estimated to account for 1 in 5 Aboriginal deaths and has declined only slightly over recent years, indicating that quit smoking programs have largely not been effective for Aboriginal people.

The Tackling Smoking Healthy Lifestyles team is committed to moving Towards A Smoke Free Kimberley (TASK). One of our key contractual initiatives with our funding body is to develop a localised social marketing campaign tailored towards motivating local people to make a quit attempt. The aim of a localised approach is to ensure that the campaign reaches out to the local Aboriginal population in a way that will positively start the journey towards becoming smoke free. Community & stakeholder engagement is integral to the project – BRAMS, KPHU, Cancer Council are members of the TASK team.

The Social Marketing campaign is being informed by a review of existing knowledge around Health & Wellbeing, Smoking and Social Marketing as well as primary marketing research amongst people in the Kimberley. The local marketing research program will involve consultation with local people during the exploratory phase, during creative development and for evaluation purposes. The first stage is to conduct exploratory depth interviews and we will then move into focus groups to help finalise the creative for the Social Marketing campaign.

Progress: Completed in 2013

Reference: 2013-001 - Cause of mortality in people with Rheumatic Heart Disease in the Kimberley 1990-2010

Researchers: Dr Alexandra Hofer, Dr Carole Reeve, Dr Jacqui Murdoch (Kimberley Population Health Unit)

Funding:

Project summary: This project was brought about as a consequence of a recent mortality audit of the WA RHD Control Program (Ref 2011-014).

The aims of this project include the following:

  • Determine the death rates due to RHD in the Kimberley during 1990-2010 by ethnicity and age-group
  • Determine common causes of mortality in this cohort
  • Determine the prevalence of valvular surgery in this cohort

The project cohort will be identified by the Data Linkage Branch (DLB), WA and further demographic and mortality data will be collected from the Hospital Morbidity Data System and Death Registry via the DLB.

This project aims to provide more accurate Kimberley-specific mortality data to describe the burden of RHD in this region.

Progress: Completed in 2014

Reference: 2013-002 - Strongyloides and Diabetes in the Kutjungka clinics- an evaluation of current treatment

Researchers: Russell Hays (KAMSC/ James Cook University); Prof Robyn McDermott (JCU)

Funding:

Project summary: Aboriginal communities in Northern Australia have a high prevalence of infection with the soil transmitted gut worm Strongyloides Stercoralis. In addition the incidence of type 2 Diabetes mellitus is high in these communities. Some studies performed overseas suggest that there may be a relationship between worm infections and diabetes, and the coexistence of these two conditions in this community provides a unique opportunity to study the possible interactions between the two illnesses.

It is now possible to accurately diagnose Strongyloides infection using an ELISA blood test, and treat it adequately using oral Ivermectin according to the best practice guidelines available. Treatment using this regimen has been underway in the Kutjungka clinics for the past year. This project aims to evaluate the effectiveness of this treatment regimen in the Kutjungka clinics with particular reference to the relationship between Strongyloides and T2DM, and the effect that treatment has on the control of T2DM.

Progress: Ongoing

Reference: 2013-003 - Audit of Kimberley hospitals discharge data for acute rheumatic fever and rheumatic heart disease, 2002-2012

Researchers: Dr Jacqueline Murdoch Kimberley, Dr Carole Reeve (Kimberley Population Health Unit)

Funding:

Project summary: The Western Australian Rheumatic Heart Disease Register was created in 2009 to provide best practice care to WA patients diagnosed with acute rheumatic fever with or without rheumatic heart disease. The register currently uses a passive case finding technique to identify patients to consent once notifications are received. It is expected that due to this technique, and the recency of the register, there are a significant number of patients who are eligible to be on the register but have not yet been given this opportunity. This project aims to use the discharge data from Kimberley region hospitals to ensure that eligible patients are offered the chance to consent to the register in order to assist with the coordination of their care and the delivery of antibiotic prophylaxis, if necessary. This project is expected to be extended to a state-wide project to improve the accuracy and therefore utility of the WA RHD Register.

Progress: Completed

Reference: 2013-004 - Missing Voices: Communication difficulties after stroke and traumatic brain injury in Indigenous Australians

Researchers: Prof Elizabeth Armstrong, A/Prof Deborah Hersh (Edith Cowan University); A/Prof Judith Katzenellenbogen, A/Prof Julianne Coffin, Prof Sandra Thompson (Combined Universities Centre for Rural Health/UWA); Prof Colleen Hayward (Kurongkurl Katitjin, Edith Cowan University); Deborah Woods (Geraldton Aboriginal Medical Service); Prof Leon Flicker (Royal Perth Hospital/University of Western Australia); Dr Natalie Ciccone (Edith Cowan University)

Funding: NHMRC

Project summary: Acquired Communication Disorder (ACD) is a common consequence of stroke and traumatic brain injury (TBI). These both occur at a higher rate and a much younger age in Indigenous compared to non-Indigenous Australians. ACD has a devastating impact on individuals and their families in the general population, and yet virtually nothing is known about Indigenous people’s experiences of this disorder. Their uptake of speech pathology services is minimal, and to date, short and long-term outcomes are unknown. This study will provide the first comprehensive and significant information on adult Indigenous Australians’ experiences of ACD, and one of the first in the world on Indigenous issues related to such disorders. This is also the first study to address the lack of uptake of Speech Pathology services by Indigenous Australian adults, in relation to both rural and urban Indigenous communities.

The study aims to:

  1. Investigate, using current administrative data, the extent and impact of ACD in urban and rural Western Australian Indigenous populations following stroke or TBI.
  2. Develop and validate a culturally appropriate communication disorder assessment tool for screening by health professionals who are working with Indigenous people after stroke and TBI.
  3. Describe the current status of communication rehabilitation services for Indigenous people.
  4. Develop potential alternative service delivery models that are accessible and culturally appropriate based on the reported experiences of health service providers and the individuals and their families experiencing these disorders.

The research team is comprised of Indigenous and non-Indigenous researchers and will follow a strongly consultative model involving interviews, focus groups and workshops with people with ACD and their families and a range of health professionals. In addition, information will be obtained from existing data sets that will highlight the frequency of communication disorders and services accessed, and will inform the development of future culturally appropriate and accessible rehabilitation services.

Progress: Ongoing

Reference: 2013-005 - What are the outcomes for children with middle ear disease in a remote Kimberley community? Three year follow up of participants in the 2010 Noonkanbah ear health audit

Researchers: Dr Jacqueline Murdoch, Dr Carole Reeve (Kimberley Population Health Unit)

Funding:

Project summary: An ear health audit of 86 children in Yungngora community at Noonkanbah station was conducted in 2010. The children’s ears were screened using clinical history, examinations and hearing tests. The 2010 audit reported that 74% of the children had middle ear disease, 36% had perforations of their ear drums and 14% were referred for urgent review by specialists. The children were then treated and followed up over a three week period using the Kimberley Ear Health Protocol, which guides clinical practice in remote Kimberley communities.

This project will follow up these children three years later to assess the current state of their ear health by auditing the participants’ charts and providing ear health checks for any children who have not had their ears assessed in the past 12 months, as per current guidelines. It will allow us to track the progress of the children in the initial cohort and compare their current ear health with that at their initial assessment.

Progress: Completed

Reference: 2013-006 - An app to support suicide prevention amongst Indigenous youth: Pilot

Researchers: Professor Helen Christensen, Dr Fiona Shand, Rebecca Ridani (Black Dog Institute); Dr Kathryn McKay (University of New England); Joe Tighe, Joshua Sibosado, Craig Sampi (Alive and Kicking Goals)

Funding: Australian Government Department of Health and Ageing

Project summary: The Black Dog Institute is partnering with Alive & Kicking Goals! (AKG), a suicide prevention initiative currently in place in the Kimberley, to develop a suicide prevention app for mobile tablets. Phase one of the project involved running focus groups in the Kimberley region to find out how an app might benefit Indigenous youths. The information from focus groups was collated, and an app was designed to meet the needs of Indigenous youth. This phase of the project involves running a pilot of the app to determine whether the self-help interactive program delivered via tablet devices can help Indigenous youth to reduce their suicidal ideation. Participants will be randomly assigned to either the intervention group, which includes therapeutic activities grounded in acceptance and commitment therapy, or a wait list control group who will receive the intervention after the first group finishes. We predict those using the intervention program will report reduced suicidal ideation and mental distress after using the program for 6 weeks.

Progress: Ongoing

Reference: 2013-007 - Young Aboriginal Women's Voice on Pregnancy Care

Researchers: Tracey Reibel, Lisa Morrison (Telethon Institute for Child Health Research); Anne-Marie McHugh, Llinios Chapman (AMSSU)

Funding: WA Department of Health through and ongoing contract with the Telethon Institute that supports a range of research across the WA Health system

Project summary: The Aboriginal Maternity Support Services Unit (AMSSU) requested the Telethon Institute for Child Health Research undertake a qualitative research approach to finding out how antenatal services can encourage young Aboriginal women to attend antenatal care from early in their pregnancy.

This project will use qualitative data collection methods (semi structured individual and small group yarning sessions) informed by culture care theory and the literature on cultural security and cultural safety in Aboriginal consultations. The project outcomes are intended to provide recommendations to the AMSSU which will assist the AMSSU to establish a standard set of guidelines and/or a model of care framework that effectively promotes and provides pregnancy care to young Aboriginal women. These would then be disseminated to all antenatal services in Western Australia to underpin changes in service delivery.

The hypothesis is that: access to and use of antenatal services by adolescent Aboriginal women is likely to be improved by the availability of culturally and age appropriate services. Some evidence suggests that young pregnant Aboriginal women may have different antenatal care needs to their older counterparts. As adolescent pregnancies may result in low birth weight and premature birth, both of which have a significant negative impact on whole of life outcomes for the infant, the antenatal period is deemed crucial for interventions to address nutrition, alcohol, tobacco and other substance use, and other factors affecting the health of the mother and baby. Aboriginal mothers are more likely to have their babies at a younger age compared to non-Aboriginal mothers. As well as potentially poorer obstetric outcomes, adolescent mothers may also be exposed to poorer educational and economic outcomes.

This project is focussed on developing an understanding of what adolescent pregnant Aboriginal women want or need for their pregnancy care in order to match their expectations in the organisation and delivery of safe and secure services that are likely to use.

Progress: Completed in 2014

Reference: 2013-009 - A national population based study of rheumatic heart disease in pregnancy

Researchers: Prof Elizabeth Sullivan (National Perinatal Epidemiology and Statistics Unit); Prof Jonathan Carapetis (Telethon Institute of Child Health Research); Dr Warren Walsh (Prince of Wales Hospital); Prof Michael Peek (The University of Sydney Sydney Medical School Nepean); Dr Marie Claire McLintock (National Women’s Health Auckland City Hospital); Prof Sue Kruske (University of Queensland)

Funding: NHMRC Project Grant 1024206

Project summary: Rheumatic heart disease (RHD) in pregnancy (a serious consequence of repeated episodes of rheumatic fever, caused by Group A streptococcus) results in heart valve damage. It is a preventable disease and neglected public health problem, associated with poverty and overcrowding. Aboriginal and Torres Strait Islanders in remote regions of Australia and Māori and Pacific Islander peoples in New Zealand have among the highest documented rates of RHD in the world. A group of Aboriginal and non-Aboriginal researchers based at UNSW has received a four-year NHMRC funding grant (2012-2016) to study RHD in pregnancy using the AMOSS (Australasian Maternity Outcomes Surveillance System).

Increased cardiac demands of pregnancy (including up to 50% increased blood volume) can unmask previously undiagnosed RHD and exacerbate symptoms, particularly where there is mitral stenosis, or for women with mechanical heart valves. Yet little research has been carried out with clinical recommendations largely based on generic studies of severe disease in non-pregnant adults. Optimal management can be hampered by limited cardiac services in remote areas, turnover of health staff, and delayed attendance at clinics due a lack of trust and sense of cultural safety.

The mixed methods research includes a quantitative study with nearly 300 maternity units across ANZ and a qualitative study (in NT and NSW) exploring women’s journey with RHD. It will provide an evidence base with a view to improving clinical care and outcomes for women with RHD in pregnancy and their babies. It will investigate the largest population based group of pregnant women with RHD ever systematically studied globally and outline patterns of health risk, diagnosis, course, management and pregnancy outcomes.

The study will enable benchmarking to identify key attributes of successful, culturally safe models of health care for women with RHD in pregnancy, based on working with those who experience RHD and its impact. It will inform approaches to RHD in pregnancy in ANZ and internationally with other RHD stakeholders in the Pacific region, and have direct benefit to the disproportionately Indigenous women with RHD.

Progress: Ongoing

Reference: 2013-010 - Evaluation of the Western Australian Rheumatic Heart Disease Register

Researchers: Dr Philippa Chidgzey, Janice Forrester, Dr Carole Reeve, Dr Peta Williams (Kimberley Population Health Unit); Dr Stephanie Davis (Australian National University)

Funding:

Project summary: The Western Australian (WA) Rheumatic Health Disease (RHD) Register is the surveillance system to be assessed in this evaluation. The register is a part of the WA RHD Control Program which aims to maintain an effective register, improve the clinical care of patients and provide data for the monitoring of Acute Rheumatic Fever (ARF) and RHD(2). The main aims of the WA RHD Register are to:

  • Identify and register new cases of ARF and RHD
  • Use data to monitor patient outcomes and improve program strategies

Evaluation will primarily be undertaken through interviews and surveys of key stakeholders that provide information to the Register and use the data for policy and decision making. The register will be accessed for the purposes of data analysis and the assessment of key attributes. The purpose of this evaluation is to assess whether the register is meeting its purpose and objectives, which will be linked to the national key performance indicators for the Rheumatic Fever Strategy(3). Conclusions and recommendations from this evaluation will be shared with the RHD WA Clinical Advisory Group and other important stakeholders.

The main purpose of the evaluation of the WA RHD Register is to:

  • Assess whether the register is fulfilling its purpose and objectives;
  • Assess how useful the register is for public health control of RHD, which will include the assessment of specific attributes of the register;
  • Distribute findings from the evaluation and provide recommendations to improve effectiveness of the Register to improve service delivery and outcomes for people with ARF and RHD.

Progress: Onging

Reference: 2013-011 - Impact of Australia's HPV vaccination program on prevalence of HPV genotypes in Aboriginal and Torres Strait Islaner women attending for pap testing (VIP-I)

Researchers: John Kaldor, Dina Saulo, Skye McGregor (Kirby Institute, University of New South Wales); Suzanne Garland, Sepehr Tabrizi (Department of Microbiology and Infectious Diseases, The Royal Women’s Hospital); Bette Liu (The Sax Institute); Julia Brotherton (Victorian Cytology Service)

Funding: Australian Department of Health and Ageing

Project summary: Between 2013-2014 Aboriginal Health Services are being invited to participate in a follow-up study to gauge the impact of vaccination programs on prevalence of HPV genotypes in Indigenous women attending for Pap testing.

Aims:

  1. To estimate the proportion of Indigenous women who have been vaccinated among 18-26 year old women attending for Pap testing
  2. To estimate and compare the prevalence of HPV types (including vaccine-specific types 6/11/16/18 and other high risk HPV types) among Indigenous women in the post-vaccine era compared to the pre-vaccine era

To ensure a comparable sample, 6 sites who previously participated in the WHINURS study will be approached with the goal of recruited upwards of 220 Indigenous women over the study period. At eligible sites, all women aged between 18-26 years, and presenting for an episode of care that includes a Pap test will be eligible and invited to participate in the study. All women who agree to participate and sign a consent form will, in addition to their routine Pap smear, have part of the sample of the endocervical cells taken for the smear stored in ThinPrep medium and transported to the WHO Reference Lab at the Royal Hospital for Women in Melbourne for HPV DNA testing. Samples will include personal identifiers and a unique person study number so that results can be reported back to clinical sites.

In order to compare the study population sampled to previous studies, all women who consent will also be asked to complete a brief questionnaire asking about their age, postcode of residence, education, number of past partners, age of first intercourse, use of hormonal contraception, smoking,receipt of HPV vaccine and the number of doses. Their doctor/health care worker will also be asked to indicate their most recent pap result. An optional consent section for the study group will request access to the participant’s HPV vaccination status from state and national registers.

All study participants will have standard clinical care and pap test follow-up. The results of the HPV DNA testing will be reported to the doctor/health care worker but as there are no specific guidelines for patients with normal Pap results that are positive for high risk HPV DNA, a clinical algorithm was developed, utilising international evidence and expert opinion, for the WHINURS study. All participants who test positive for the presence of high‐risk HPV DNA will be invited back for a repeat HPV and pap test 12 months after the initial test.

Progress: Ongoing

Reference: 2013-013 - Investigation of inefficacious release of fentanyl patches used by Aboriginal patients in the remote Kimberley region of Western Australia

Researchers: Prof. Bruce Sunderland Dr. Victor Chuang, Matthew Schmidt (Curtin University); Ms Stefanie Oliver (KAMSC)

Funding:

Project summary: Extreme fluctuations of temperature and humidity occurring at many remote and tropical areas make proper storage of medications a big challenge, as the efficacy of drugs is at stake when medicines are stored outside of manufacturer’s requirements. This undoubtedly will bring detrimental impact on the health care service provision to the remote communities. Lately, there have been some isolated reports that dialysis patients using fentanyl patches at the remote Western Australian town of Broome and other remote areas of the Kimberley region were experiencing an increased effect within the initial 24 hours then no effect for the remainder of the 3 day time frame for the patch. More data needs to be collected to give an accurate picture of the causes of the inefficacious patches in search of a solution to resolve the treatment failure issue. This study aims to investigate patient related and transdermal patch related factors, with a focus on the impact of heat, which could have caused problematic release profiles of the patches. The results of this study should provide a ground for changes to be made in order to improve health outcomes in the Aboriginal communities in the Kimberley region, and the use of patches in tropical climates

Progress: Ongoing

Reference: 2013-014 - How do you decide? Experiences and influences promoting best practice and engagement within Aboriginal health

Researchers: Dr Andrea McKivett, A/Prof Dr David Paul (The University of Western Australia); A/Prof Shaun Ewen (Melbourne School of Population and Global Health)

Funding:

Project summary: The poor state of health in the Australian Aboriginal population is a well known fact. Australian Aboriginal patients suffer poor outcomes of health secondary to a wide number of factors. As health professionals, we have a responsibility to ensure best practice for our individual patients is implemented to enable the achievement of good health outcomes.

The goal of this research project is to, through discussion with medical practitioners, explore significant experiences and influences on decision-making and preparedness to engage in Aboriginal health.

A persons willingness to engage, manage, and potentially advocate for the needs of another is one of the great aspects of medicine. This study hopes to discuss this very notion and seek to explore what encourages this in Doctors. This could potentially lead to further ideas on how to apply such factors to the broader medical community. Not only is effective engagement important in working towards building better outcomes in the health system, it can be applied to the general community when working towards reconciliation.

The clinical-decision making process is a complex one, and has been addressed in recent literature. This process is a core component of the implementation of best practice, and will be looked into in this study. This study aims to explore different experiences and influences that medical practitioners have that may work in with their decision-making process, promoting best practice in Aboriginal health

The study will involve qualitative research obtained through short, 15-20 minute semi-structured interviews involving medical practitioners.

The improvement of Aboriginal health outcomes along with advocating for a better future for the Aboriginal population is a clear goal driving this research project. The research hopes to contribute to the medical community through the discussions had with participants regarding their experiences and influences that promote best practice and engagement in Aboriginal health. Any key influences or experiences found may then be utilised in guiding future educational and training tools for medical practitioners. This would work towards ensuring the ongoing effective development of training medical practitioners in the field of Aboriginal health and the ongoing implementation of best practice.

Progress: Ongoing

Reference: 2013-016 - West Kimberley Youth Photovoice Project pilot study to assess youth strengths and assets in the community

Researchers: Katy Crawford(KPHU); Deb Carter Nindilingarri Cultural Health); Bec Morgan (KPHU); Bronwyn Lovell, Joshua John (Kimberley Training Institute); Roanna Lobo (SiREN, Curtin University)

Funding:

Project summary: Photovoice is a participatory research method considered as a useful tool in understanding the needs of a vulnerable population. It overcomes barriers such as low literacy levels and promotes self esteem. Photovoice provides an opportunity to identify perceived strengths and opportunities for enhancing these qualities.

The Kimberley region has endemic rates of Chlamydia and Gonorrhoea with the majority of notifications in the16-24 year old age group. Traditional health promotion needs assessments of young people are focused on ‘negative’ behaviours and health outcomes. The findings from this Photovoice activity will instead identify assets that can be enhanced and supported in future health promotion activities.

The pilot project will run over a 6 week time period and will begin with a discussion about project expectations from all stakeholders including participants. Training will involve basic photography skills, multimedia use and facilitation of discussions around approaches to addressing the questions, concerns and barriers.

Possible questions/themes to be addressed in the project include:

  • Who do you talk to about sex?
  • How do you communicate with your friends and family?
  • What is your favourite thing to do when you are bored?
  • What makes you healthy or strong?

After the participants have taken and selected photos individual and group discussions will take place around perceived photo meanings. The group will present and discuss the findings with the wider project team.

Progress: Ongoing

Reference: 2014-001 - Acute Rheumatic Fever increase in Western Australia

Researchers: Philippa Chidgzey (KPHU); Janice Forrester, Pauline Martin, Lynette Masuda, Bec Morgan-Dann (WA RHD Control Program); Stephanie Trust, David Atkinson, Rhona Dawson (Kimberley Aboriginal Medical Services Council); James Ramsey, Narissa Wieland, David Andrews (Princess Margaret Hospital); Claire Waddington (Telethon Institute for Child Health Research); Stephanie Davis (Australian National University); Peta Williams, Jeanette Ward (Kimberley Population Health Unit)

Funding:

Project summary: Acute Rheumatic Fever (ARF) is an illness that may result following an infection with bacteria named Group A Streptococcus (GAS). There are many different types (strains) of GAS. The circulating strains change over time, and it is also known that some strains are more likely than others to cause ARF. ARF affects the skin, bones and brain, but most importantly can affect the heart, which can result in an illness termed Rheumatic Heart Disease (RHD). RHD means that the heart valves do not work properly and then blood is not pumped properly, and this can make a person feel tired and short of breath. If the RHD is very severe, a person may need heart surgery, have a stroke or may die. Unfortunately in Australia, ARF and RHD now mostly affects Aboriginal and Torres Strait Islander people(5).

ARF is a condition that the government in Western Australia monitors (via a process called notification) as it can be prevented through medications and improved living conditions. Doctors need to tell the health department when they think a person is affected by ARF. Over the past year, doctors have reported many more cases of ARF across WA, but mostly in Perth, Broome and Fitzroy Crossing. Similarly, the main children’s hospital in WA, Princess Margaret Hospital, has also reported that they are seeing more severe cases of ARF. This may mean that there is a more harmful strain of the GAS bacteria infecting children.

The reasons for this possible increase in the number of people getting ARF are not known (examples of possible reasons are: greater awareness of the requirement to report ARF; a strain of GAS is circulating that is more likely to cause ARF; or that the environmental conditions contributing to ARF have been worse over the outbreak period).

We would like to investigate whether there really are more cases of ARF occurring in WA. We would do this by looking at ARF notification data and data from ARF related hospitalisations to establish the baseline rate of ARF in WA since 2001. We would compare current numbers of ARF cases with numbers of cases from previous years to establish whether a true increase has occurred (a disease outbreak). If we establish that an outbreak is occurring, then control measures may be put in place to prevent more people developing ARF and RHD.

Progress: Ongoing

Reference: 2014-004 - Descriptive analysis of community-associated methicillin-resistant Staphylococcus aureus and its burden on health services in Kimberley, Western Australia

Researchers: Dr Anna Beswick, Dr Paul Armstrong (Communicable Disease Control Directorate, Department of Health)

Funding:

Project summary: The Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research have, since 1997, been referred all isolates of MRSA in WA. The CDCD use this data to formulate strategies to reduce morbidity and mortality from MRSA. Over the last ten years there has been a dramatic increase in incidence of CA-MRSA infections across Australia, most marked in the Kimberley region (see appendix two of project proposal). It is hoped that by reviewing the burden of CA-MRSA cases on Kimberley emergency and inpatient health services, and by determining if particular strains are associated with deaths, co-morbidities, hospital attendances or the necessity for a procedure, that these findings can then be used to guide future strategies for the management of CA-MRSA within the Kimberley region and elsewhere in WA.

Progress: Ongoing

Reference: 2014-005 - An investigation into the factors that facilitate and impede food security in remote Aboriginal communities in Fitzroy Valley

Researchers: Clint Bussey, Dr Darlene McNaughton, Dr Sue Booth (Flinders University)

Funding:

Project summary: Leading health organisations have recently described food security as the missing link in closing the gap between Indigenous health and the health of non-Indigenous Australians.

The project is the first of its kind in Australia and aims to investigate factors which promote as well as impede food security in Gooniyandi communities throughout the Fitzroy Valley region of the Kimberley. This study will include semi-structured qualitative interviews and ‘participant observation’ to explore how behaviours and lived practices influence household food security.

The project is strongly supported by community members, chair people and health organisations including Nindilingarri Cultural Health Services, Prescribed Body Corporate (Gooniyandi) and the Kimberley Aboriginal Law and Culture Centre.

This project draws on ethnographic methodology to identify factors that facilitate or impede the diet quality of Aboriginal people living in remote communities and how these factors influence the four pillars of food security as defined by the Food and Agriculture Organisation. The four pillars are:

  • Food access
  • Food availability
  • Food use and
  • Food stability

Information about the dietary intakes and behaviours involving Aboriginal people is either dated, limited in depth or resourced from the community store. Many generalisations and assumptions continue to be made about the diets of Aboriginal people and there is little focus on exploring significant factors that determine diet quality from the perspective of Aboriginal people. It remains increasingly important that Aboriginal people’s knowledge, values and concerns about food and their diet are taken into account when determining the level of food security in their community.

The information and project findings will assist in developing a broader understanding into the complex nature of food security issues in remote Aboriginal communities. Improving food security will benefit the health of a significant proportion of Aboriginal people that live in remote communities.

Progress: Ongoing