Current Research Projects

Below are links to the information pages on the current KAMS and Kimberley RCSWA research projects. For further information please contact:

Associate Professor Julia Marley
08 9194 3200 or


ORCHID Study: Predicting gestational diabetes mellitus in rural communities

Developing algorithms to improve predicting the development of and screening for GDM in rural communities

Gestational diabetes mellitus (GDM) is impaired glucose tolerance first detected in pregnancy. GDM is associated with a range of adverse neonatal and maternal outcomes. GDM is the commonest maternal antenatal abnormality in Australia. Screening is conducted in order to detect women at risk of disease, facilitating earlier management and treatment. Currently available evidence indicates that treatment of GDM with dietary modifications, glucose monitoring, and metformin and insulin (if needed) can significantly reduce the risk for adverse birth outcomes.

Current screening recommendations are for all pregnant women who are not known to have diabetes or GDM to have an oral glucose tolerance test (OGTT) at 24-28 weeks gestation. Women need to be fasted for this test and blood samples are taken immediately prior to consumption of a 75g glucose drink, and 1 and 2 hours later. Many women decline screening.

Alternative methods for diagnosing GDM or alternative methods for screening that lead to a reduction in the number of OGTTs required need to be found if we are to improve screening rates. We want to see if levels of glycation products such as HbA1c at first and third trimester antenatal visit predict the risk of developing GDM later in pregnancy or can be used instead of OGTT where an OGTT is difficult to achieve or refused by the patient.

The aims of this project are:

  • To determine at baseline the number of 24-28 week OGTTs completed on at least 100 antenatal patients in each study region expected to have had an OGTT.
  • To determine the relationship between first trimester antenatal information, including glycation products such as HbA1c, blood sugar levels, family history, obesity, maternal age, ethnic background, and 24-28 week glycation products, with 24-28 week OGTT.
  • To determine the proportion of women enrolled in the study requiring an OGTT who complete the OGTT at 24-28 weeks gestation.
  • To increase research interest and capacity among health service and RCSWA staff and students, and to build skills in rural and remote health service research.

To ensure that the project findings are generalisable to the broader regional, remote primary health care environment, it will be carried out in a range of health care services across Western Australia: Kimberley, Southwest, Greater South, Midwest and Goldfields.

This project is a collaboration between The Rural Clinical School of WA, KAMS, WA Country Health Services – Kimberley, Harry Perkins Institute and is funded in part through an RCSWA Multi-site Project Grant, Lishman Health Foundation grant and Diabetes Australia grant.

Progress to date: We are in the final stages of data collection.


Kirke AB, Atkinson D, Moore S, Sterry K, Singleton S, Roxburgh C, Parrish K, Porter C, Marley JV. Diabetes screening in pregnancy failing women in rural Western Australia: An audit of oral glucose tolerance test completion rates. Aust J Rural Health 2019.


Plain language report for audit


  • Assoc Prof Julia Marley, RCSWA Broome
  • Erica Spry, KAMS
  • Emma Jamieson, RCSWA Bunbury
  • Dr Andrew Kirke, RCSWA Bunbury
  • Dr Kylie Sterry, RCSWA Kalgoorlie
  • Dr Sarah Moore, RCSWA Bussleton
  • Dr Carly Roxburgh, RCSWA Albany
  • Dr Sally Singleton
  • Dr Emma Griffiths, KAMS
  • Dr Cynthia Porter, GRAMS
  • Prof David Atkinson, RCSWA Broome

Prevention of type 2 diabetes amongst young Aboriginal people in Derby, Western Australia

Type 2 diabetes (T2DM) is a largely preventable disease that involves a significant burden on individuals and communities. Aboriginal and Torres Strait Islander people have higher rates of T2DM than other Australians in all age groups, with larger differences in younger age groups – a time when the onset of diabetes is associated with earlier progression to serious health complications.

The primary prevention of T2DM though lifestyle modification, for people who may have pre-diabetes and for communities in general, is considered to be a beneficial approach. In this project, under the guidance of the Derby Aboriginal Health Service (DAHS), young people in Derby will be actively involved in developing and implementing an intervention to support lifestyle changes with a view to preventing T2DM. The overall aim of this PhD project is to contribute to the prevention of type 2 diabetes amongst young people in Derby through supporting healthy lifestyle changes.

The specific aims of this project are to:

  • Describe the pattern of glycated haemoglobin (HbA1c) levels in young Aboriginal people in Derby (15-39 years of age, with a major focus on 15-25 years of age), and identify the factors associated with individuals having improved glycaemic control over time.
  • Identify lifestyle interventions that are acceptable to young people in Derby and are considered to be of most potential benefit for them.
  • Trial a pilot community-driven lifestyle intervention with DAHS and assess acceptability and the short-term outcomes of this intervention.

Progress so far:

De‐identified electronic patient medical record data were analysed, focusing on glycated haemoglobin (HbA1c) measurements along with body weight and age. Results were suggestive of increasing T2D risk by mid-20s, with some young people found to have T2D earlier than this. The minimum T2D prevalence among people aged in their 30s was 10%. This reinforces the need for regular universal T2D screening from a young age. Consistent with previous studies with other populations, results were also suggestive of increased risk of progression to T2D from high-range pre-diabetes (HbA1c 42–47 mmol/mol, 6–6.4%), particularly for people who gained weight. We aim to strengthen conclusions by expanding this analysis to include the wider region, to enhance evidence-based local diabetes screening guidelines. Improvements in screening practices will contribute to targeted use of preventive interventions as well as timelier diabetes diagnoses that can minimise complications.

A paper has also been published about Derby residents who had made successful healthy lifestyle changes before this project started. Four men aged 20–35 years were interviewed; three had diabetes, with diagnosis occurring in their early 20s. Participants with diabetes were highly motivated to avoid diabetes complications and had a strong belief that their actions could achieve this. The findings from this study highlight that lifestyle modification programs that foster internal motivation, enhance key health knowledge, and modify health beliefs and risk perception are needed. These insights were incorporated into the pilot program.

A diabetes prevention / healthy lifestyle program for young people was developed in Derby, based on the ideas and advice of Derby community members and previous research evidence. A paper has been published about the pilot program held at DAHS in 2017. Ten Aboriginal women and men aged 18–38 years participated in the pilot program, which had local young Aboriginal facilitators. The 8-week program highlighted causes and consequences of diabetes, incorporated physical activity and healthy eating topics with a focus on practical activities, and included stress management to support healthy lifestyles. The program was found to be acceptable and appropriate, and other community members and organisations expressed interest in future participation. Participants reported that they gained important new knowledge and made changes in behaviours including shopping choices, portioning and soft drink consumption. While this program was designed to be sustainable, and there were indications of feasibility, resource constraints impeded its integration into routine primary health care. Prevention of diabetes is a high priority for DAHS, and this program, with appropriate resources, provides a basis for ongoing practical prevention strategies.

Another paper about the co-design of the program is undergoing peer review. We hope information about this program will be useful in developing localised prevention programs elsewhere.


Seear KH, Lelievre MP, Atkinson DN, Marley JV. ‘It’s important to make changes.’ Insights about motivators and enablers of healthy lifestyle modification from young Aboriginal men in Western Australia. Int J Environ Res Public Health. 2019; 16:1063. Available from:

Seear KH, Atkinson DN, Henderson-Yates LM, Lelievre MP, Marley JV. Piloting a culturally appropriate, localised diabetes prevention program for young Aboriginal people in a remote town. Aust J Prim Health 2019; DOI 10.1071/PY19024. Available from:


‘Maboo wirriya, be healthy’ program facilitator manual (7MB)

It’s important to make changes – peer reviewed publication (416 KB)

It’s important to make changes – plain language report (164 KB)

Be Healthy Program Pilot – plain language report (166 KB)


  • Kimberley Seear, PhD Candidate, RCSWA Derby
  • Assoc Prof Julia Marley, RCSWA Broome
  • Matthew Lelievre (formerly DAHS)
  • Prof Lynnette Henderson-Yates, DAHS
  • Prof David Atkinson, RCSWA Broome

Kimberley Investigation and Description of type 2 Diabetes of Young-onset (KIDDY)

Young-onset diabetes refers to type 2 diabetes mellitus (T2DM) that is first diagnosed at a young age (less than 25 years old). The number of people being diagnosed with young onset diabetes is increasing around Australia, particularly in Aboriginal or Torres Strait Islander youth. This is concerning because young-onset diabetes has been shown to be a more aggressive version of diabetes than the later-onset type, and is associated with earlier progression to complications. These complications can include damage to the eyes (retinopathy), kidneys (nephropathy), nerves (neuropathy) and the heart and brain (cardiovascular disease).  Importantly, there are things that can be done, which can prevent or slow down the onset of these complications.

We are concerned at some of the preventable early complications that we are seeing in young people with diabetes in the Region. We would like to be able to work out the best way to support young people with young-onset diabetes across the Kimberley.

What will this evaluation project involve?:

  • Describing the current situation of young-onset diabetes in the Kimberley
  • Identifying best practice screening guidelines for young-onset diabetes in our region


  • Dr Sally Singleton, KAMS and RCSWA
  • Dr Gavin Cleland, WACHS-Kimberley
  • Dr Lydia Scott, WACHS-Kimberley
  • Miss Andreana Manifold, RCSWA
  • Dr Jaye Martin, WACHS-Kimberley
  • Assoc Professor Julia Marley, KAMS and RCSWA
  • Prof David Atkinson, RCSWA

Kidney Disease

Clinical review of dialysis patients originating in the Kimberley region

Over the past 20 years an epidemic of end-stage kidney disease (ESKD) has occurred among Aboriginal and Torres Strait Islander people in remote areas of Australia. The Kimberley Satellite Dialysis Centre (KSDC) was established in October 2002 in recognition of the growing need for dialysis in the Kimberley and after requests from patients to be able to dialyse in the region. Prior to this patients requiring haemodialysis either relocated to Perth for treatment or stayed at home to die.

Most reports on kidney disease in the Australian Aboriginal and Torres Strait Islander population in scientific journals describe the progression of kidney disease and treatment options prior to dialysis. There are very few published reports on health outcomes, including survival times for Aboriginal and Torres Strait Islander patients on dialysis.

The aims of this study are:

  • To determine the future need for dialysis in the Kimberley
  • To undertake a clinical audit of the implementation of best-practice guidelines for Kimberley clients with proteinuria and chronic kidney disease
  • To determine the outcomes of haemodialysis and peritoneal patients in the Kimberley


  • Assoc Prof Julia Marley
  • Prof David Atkinson

Progression of chronic kidney disease to end stage: A retrospective cohort study from the Kimberley region

Chronic kidney disease (CKD) is a significant health problem within Australia; accounting for almost $900 million in health care expenditure in 2004-05. Rates of detected CKD in the Kimberley region continue to increase.

Within Australia, rural and remote Aboriginal and Torres Strait Islander people are some of the most significantly affected by CKD. This is reflected by higher incidence rates of CKD within this population, particularly end-stage kidney disease (ESKD) where renal replacement therapy (RRT) is required to sustain life.

Certain risk factors have been well established to contribute to the development, and worsening of pre-existing CKD. These include diabetes, cardiovascular disease and smoking. A growing body of evidence is also supporting a link between acute kidney injury and the progression of exiting CKD. The relative contribution of acute and chronic stressors to the progression of CKD in the Aboriginal population has not been previously documented. This study will aim to address this gap.

The aims of this study are:

  • To identify the number of episodes of acute kidney injury in a cohort of patients with CKD
  • To describe the cause and severity of these acute kidney injury episodes
  • To compare the progression of chronic kidney disease towards ESKD between people with CKD with and without a history of acute kidney injury, whilst identifying and controlling for chronic disease indicators that are known to increase the risk of progression to ESKD
  • To document service indicators (care provided by the Kimberley Renal Services and visiting nephrology services) and the impact on risk of progression to ESKD.


  • Dr Emma Griffiths
  • Joseph Mohan
  • Marcin Skladaniec
  • Prof David Atkinson
  • Assoc Prof Julia Marley

Palliative care in end stage kidney disease: Are we meeting the needs of our Indigenous clients?

Palliative care has been integrated into the kidney disease pathway care plan in the last few years. However no study to date has been done to ascertain if we are meeting the needs of our renal clients in their last days and weeks of life. As the burden of kidney disease has reached epidemic proportions in the Kimberley it is important to ensure that renal clients have an understanding of palliative care and the support it can provide. In order to deliver a quality service in line with the National guidelines it is imperative that we seek clarification from our Aboriginal clients on what their needs are in end of life care. This will help determine if we are meeting the needs of our Aboriginal renal clients.

We will conduct a twofold study to investigate this question further. Firstly a retrospective case note study from 5-10 renal clients who either opted to discontinue dialysis or renal replacement therapy was no longer an option. We will identify their use, if any, of palliative care and when discussions around end of life took place.

The second part of the project will be a qualitative investigation in the form of open ended interviews with a cohort of 10-12 renal clients. The participants will be from amongst the clients who attend the Kimberley Satellite Dialysis Centre. Questions will be aimed at learning end of life wishes, palliative care conceptions and when initial palliative care discussions first began and how these were perceived. This will give insight into the expectations of clients in their last days and weeks of life and their understanding of palliative care.

It is hoped that following evaluation of this research it will inform future program development and improve quality of palliative care service delivery for renal clients in a culturally appropriate and timely manner.


  • Jenny Costigan
  • Assoc Prof Julia Marley
  • Prof David Paul
  • Prof David Atkinson

Social & Emotional Wellbeing

Improving mental health screening for Aboriginal and Torres Strait Islander pregnant women and mothers of young children

This study aims to improve screening for, and contribute to addressing, mental health issues during pregnancy and the first 12 months after the birth of the baby.

The locally developed, culturally appropriate and user friendly Kimberley Mum’s Mood Scale (KMMS) was validated against clinical assessment in a sample of 91 Kimberley Aboriginal women. Kimberley regional guidelines now recommend using the KMMS to screen for anxiety and depression during the perinatal period for Aboriginal women. The next step for Kimberley health services are to increase and improve KMMS screening in pregnancy and postnatally and address identified mental health issues. Project staff will work closely with Kimberley services to find out:

  • How the KMMS can best be implemented into routine practice in each service
  • If, during routine use:
    • The KMMS cut point of moderate still detects everyone with GP assessed clinically moderate or high severity depression and anxiety, and:
    • That the management plans developed during the KMMS for those at lower risk are appropriate.

In order to meaningfully assess the above and to test for applicability in other remote regions to inform recommendations for wider use, it is important to re-evaluate the KMMS in a larger population during real world implementation. In partnership with health services and Aboriginal communities in northern Western Australia (WA) and Far North Queensland (FNQ), this study aims to:

  • adapt the Kimberley Mum’s Mood Scale (KMMS) and develop locally appropriate versions for participating partners as required;
  • evaluate the real-world performance of KMMS in the Kimberley and other remote regions in northern Australia; and
  • evaluate the process of implementation.


Project Staff:

  • Emma Carlin, Research Fellow, RCSWA
  • Diana Jans, KMMS Research Project Officer, Apunipima Cape York Health Council, Cairns

Chief investigators:

  • Professor David Atkinson, RCSWA
  • A/Professor Julia Marley, RCSWA
  • A/Professor Mark Wenitong, Apunipima Cape York Health Council, Cairns
  • Professor Karen Edmond, Unicef and University of Western Australia
  • Dr Ernest Hunter, James Cook University, Cairns
  • Dr Catherine Engelke, Rural Clinical School of WA, WA Country Health Service – Kimberley, Kununurra
  • Professor Rhonda Marriott, Murdoch University, WA Department of Health, Perth
  • Dr Sandra Campbell, James Cook University, Cairns
  • Dr Stephanie Trust, Kununurra Medical, Kununurra
  • A/Professor Murray Chapman, Abbotsford Psychiatry, Perth

Partner Investigators

  • Ms Janet de San Miguel, KAMS, Broome
  • Dr Emma Griffiths, KAMS and RCSWA, Broome
  • A/Professor Rubin, Apunipima Cape York Health Council, Cairns
  • Dr Karla Canuto, Apunipima Cape York Health Council, Cairns
  • Ms Melissa Williams, WA Country Health Service – Kimberley, Broome
  • Dr David Cutts, WA Country Health Service – Pilbara
  • Dr Sarah McEwan, WA Country Health Service – Pilbara
  • Dr Kylee Cox, WA Country Health Service – Central Office, Perth

Associate Investigators

  • Donna Stephen, KAMS
  • Jayne Kotz, Murdoch University, Perth
  • Dr Sharon Evans, RCSWA, Perth

Improving Health Services

Accessing health care at a remote Western Australian Aboriginal Community Controlled Health Service: Pilot Study

Derby Aboriginal Health Service (DAHS) is an Aboriginal Community Controlled Health Service (ACCHS) in the Kimberley region of Western Australia.  The emphasis of the service is on Aboriginal health, preventive health, remote health, primary care and chronic disease management.  The service has a Chief Executive Officer and is run by a board of local Aboriginal people.  The buildings and infrastructure of the service have been designed to be appealing and accessible to Aboriginal people.  DAHS should be the most accessible form of health care available for Aboriginal people in Derby and surrounding communities.  In practice, however, DAHS finds it difficult to initiate and maintain relationship with many people.  Anecdotally the group which is most difficult to access is the 16-25 year old age group. DAHS would like to know why this is so.


  • To document the utilisation of health care services at a remote Western Australian Community Controlled Health Service by 16-25 year olds.
  • To identify the barriers and enablers of access for 16-25 year olds.

Findings so far:

  • 26 young Aboriginal people were interviewed.
  • Participants appreciated interacting with Aboriginal staff, local staff, and longer term DAHS staff. This improved communication and interpersonal interactions, which were reported to be of prime importance for young Aboriginal people accessing health services.
  • Maintaining confidentiality, minimising shame, and gender matching with health staff were also key issues for young people. Seeking health care was often based on acute need rather than proactive or preventive care; however, participants recognised that providing health education and health promotion should be a priority for the service.
  • Improving youth engagement seems to be central to increasing acceptability and, hence, use. This requires that staff able to engage with young people are recruited, trained, and retained. More immediately, a range of simpler changes to service provision focus and environment for young people could potentially make important differences.


Warwick S, Atkinson D, Kitaura T, LeLievre M, Marley JV. Young Aboriginal People’s Perspective on Access to Health Care in Remote Australia: Hearing Their Voices. Prog Community Health Partnersh 2019; 13:171-181.


Plain language report


  • Dr Susannah Warwick, RCSWA Derby
  • A/Professor Julia Marley, RCSWA
  • Tracey Kitaura, DAHS
  • Matthew LeLievre, DAHS
  • Professor David Atkinson, RCSWA

The NINI HELTHIWAN project: Improving Primary Care for Aboriginal mothers and babies in the Kimberley region of Western Australia

Providing quality health care for pregnant women and young children in remote areas is both vitally important and challenging. We are conducting three inter-related research projects that will contribute to the development of a regional enhanced model of primary health care for Aboriginal pregnant women and mothers of young children.

Nini regional midwife coordinators are helping to improve the support of primary care providers who are caring for Aboriginal mothers through a peer led process [telephone assistance, email, clinic visits].  Nini Helthiwan is using a randomised stepped wedge cluster design to provide this extra support by:

  • Improving guidelines and training tools for regional priorities:
    • Maternal nutrition, and substance abuse [alcohol and cigarette smoking]
    • Social and emotional wellbeing [Kimberley Mum’s Mood Scale (KMMS)]
    • Treatment and follow up practices for maternal and infant anaemia [iron infusion policy]
    • Early infant care practices [breastfeeding, bonding, attachment]
  • Assistance with problem solving and follow up [referrals, care-co-ordination, discharge planning]
  • Assistance with implementing regional guidelines:
    • Screening for perinatal anxiety and depression [Implementing the KMMS Study]
    • Screening for gestational diabetes [ORCHID Study]
  • On the job education and training, including assistance with use of electronic primary care systems.

To see if improvements in health care leads to improved health outcomes Nini regional child health workers (located in West and East Kimberley), are assessing neurodevelopment and anaemia levels in Kimberley Aboriginal babies and anaemia levels in their mothers when the baby is 6-10 months old.


  • Professor David Atkinson, RCSWA
  • A/Professor Julia Marley, RCSWA
  • Dr Stephanie Trust, Kununurra Medical
  • Dr Catherine Engelke, RCSWA
  • Kristy Newett, WACHS-Kimberley
  • Pat McCready, KAMS
  • Jo Forbes, KAMS
  • Emma Griffiths, RCSWA
  • Emma Carlin, RCSWA
  • Cath Josif, RCSWA
  • Melissa Williams, WACHS-Kimberley
  • Janet de San Miguel, KAMS
  • Dr Stephanie Sherrard, PMH
  • Prof Karen Edmond, UWA
  • Natalie Strobel, UWA
  • Rhonda Marriott, Murdoch Uni