Southgate Institute for Health, Society and Equity - Collected Works

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Integrative health care - Toward a common understanding: A mixed method study
(Elsevier, 2017-12-06) Leach, Matthew; Wiese, Marlene Louise; Thakkar, Manisha; Agnew, Tamara
Objective To generate a multidisciplinary stakeholder-informed definition of integrative health care (IHC). Methods A mixed-method study design was used, employing the use of focus groups/semi-structured interviews (phase-1) and document analysis (phases 2 and 3). Phase-1 recruited a purposive sample of Australian health consumers/health providers. Phase-2 interrogated websites of international IHC organisations for definitions of IHC. Phase-3 systematically searched bibliographic databases for articles defining IHC. Data were analysed using thematic analysis. Results Data were drawn from 54 health consumers/providers (phase-1), 23 IHC organisation webpages (phase-2) and 23 eligible articles (phase-3). Seven themes emerged from the data. Consensus was reached on a single, 65-word definition of IHC. Conclusion An unambiguous definition of IHC is critical to establishing a clearer identity for IHC, as well as providing greater clarity for consumers, health providers and policy makers. In recognising the need for a clearer description, we propose a scientifically-grounded, multi-disciplinary stakeholder-informed definition of IHC.
Burn injury models of care: A review of quality and cultural safety for care of Indigenous children
(Elsevier, 2017-11-27) Fraser, Sarah; Grant, Julian; MacKean, Tamara Jade; Hunter, Kate; Holland, Andrew J A; Clapham, Kathleen; Teague, Warwick J; Ivers, Rebecca Q
Safety and quality in the systematic management of burn care is important to ensure optimal outcomes. It is not clear if or how burn injury models of care uphold these qualities, or if they provide a space for culturally safe healthcare for Indigenous peoples, especially for children. This review is a critique of publically available models of care analysing their ability to facilitate safe, high-quality burn care for Indigenous children. Models of care were identified and mapped against cultural safety principles in healthcare, and against the National Health and Medical Research Council standard for clinical practice guidelines. An initial search and appraisal of tools was conducted to assess suitability of the tools in providing a mechanism to address quality and cultural safety. From the 53 documents found, 6 were eligible for review. Aspects of cultural safety were addressed in the models, but not explicitly, and were recorded very differently across all models. There was also limited or no cultural consultation documented in the models of care reviewed. Quality in the documents against National Health and Medical Research Council guidelines was evident; however, description or application of quality measures was inconsistent and incomplete. Gaps concerning safety and quality in the documented care pathways for Indigenous peoples’ who sustain a burn injury and require burn care highlight the need for investigation and reform of current practices.
Development and Validation of a Questionnaire to Measure Attitude change in Health Professionals after Completion of an Aboriginal Health and Cultural Safety Training Programme
(Cambridge University Press, 2017-12-11) Ryder, Courtney; MacKean, Tamara Jade; Ullah, Shahid; Burton, Heather; Halls, Heather; McDermott, Dennis Roy; Edmondson, Wendy
Socially accountable health curricula, designed to decrease Aboriginal health inequities through the transformation of health professional students into culturally safe practitioners, has become a focal point for health professional programmes. Despite this inclusion in health curricula there remains the question of how to best assess students in this area in relation to the concept, of cultural safety and transformative unlearning, to facilitate attitudinal change. To address this question, this study developed a research questionnaire to measure thematic areas of transformative unlearning, cultural safety and critical thinking in Aboriginal Health for application on undergraduate and postgraduate students and faculty staff. The Likert-scale questionnaire was developed and validated through face and content validity. Test–retest methodology was utilised to determine stability and reliability of the questionnaire with 40 participants. The extent of agreement and reliability were determined through weighted kappa and intraclass correlation coefficient. Exploratory factor analysis was calculated to determine construct validity for questionnaire items. For the overall population subset the tool met good standards of reliability and validity, with 11 of the 15 items reaching moderate agreement (κ > 0.6) and an intraclass correlation coefficient of 0.72, suggesting substantial agreement. Cronbach's alpha was calculated above 0.7 for the thematic areas. The majority of items provided high factor loadings, low loading items will be reviewed to strengthen the tool, where validations of the revised tool with a larger cohort will allow future use to compare and determine effective teaching methodologies in Aboriginal health and cultural safety curricula.
‘Yarning up with Koori kids’ – hearing the voices of Australian urban Indigenous children about their health and well-being
(Taylor & Francis Group, 2016-10-21) Priest, Naomi C; Thompson, Laura; MacKean, Tamara Jade; Baker, Alison Camelia; Waters, Elizabeth
Objective: Australian Indigenous children experience some of the most substantial health inequalities globally. In this context, research regarding their health and well-being has overemphasised physical illnesses with limited exploration of a diverse range of dimensions and determinants, particularly those based on Indigenous holistic understandings of health and well-being. This deficit-based approach has thus missed many strengths and assets of Indigenous children. This research aimed to gain insight into the perspectives of Indigenous children about their health and well-being in an urban setting in Australia. It joins a limited international literature examining views and experiences of non-majority children. Design: Participatory and qualitative child-friendly research methods were utilised. The project was developed in partnership with Indigenous community organisations and members. Photo-elicitation activities and focus groups were conducted with 31 Indigenous children aged 8–12 years. Qualitative data were analysed thematically, combining focus group and interview data. Results: It was evident an urban Indigenous child perspective of health and well-being includes rich understandings of the interconnectedness of physical, social-emotional and cultural dimensions of holism, as well as the integral importance of family and community relationships. The study also found that specific worries regarding loss of loved ones and racism were highly salient in Indigenous children’s lives. Conclusion: The overwhelming conclusion to be drawn from this research is that Indigenous children in urban areas need ongoing recognition of both their agency and resilience in the face of adversity, within a wider context of historical and contemporary racialisation and racism.
Hybrid cultures: creating a third space in Aboriginal healthcare
(Swinburne University, 2015) Willis, Eileen Mary; Dwyer, Judith Margaret; Kelly, Janet; MacKean, Tamara Jade
Understanding burn injuries in Aboriginal and Torres Strait Islander children: protocol for a prospective cohort study
(BMJ Publishing group, 2015-10-13) Ivers, Rebecca Q; Hunter, Kate; Clapham, Kathleen; Coombes, Julieann; Fraser, Sarah; Lo, Serigne; Gabbe, Belinda J; Hendrie, Delia; Read, David; Kimble, Roy; Sparnon, Anthony; Stockton, Kellie; Simpson, Renee; Quinn, Linda; Towers, Kurt; Potokar, Tom S; MacKean, Tamara Jade; Grant, Julian; Lyons, Ronan; Jones, Lindsey; Eades, Sandra; Daniels, John; Holland, Andrew J A
Introduction Although Aboriginal and Torres Strait Islander children in Australia have higher risk of burns compared with non-Aboriginal children, their access to burn care, particularly postdischarge care, is poorly understood, including the impact of care on functional outcomes. The objective of this study is to describe the burden of burns, access to care and functional outcomes in Aboriginal and Torres Strait Islander children in Australia, and develop appropriate models of care. Methods and analysis All Aboriginal and Torres Strait Islander children aged under 16 years of age (and their families) presenting with a burn to a tertiary paediatric burn unit in 4 Australian States (New South Wales (NSW), Queensland, Northern Territory (NT), South Australia (SA)) will be invited to participate. Participants and carers will complete a baseline questionnaire; follow-ups will be completed at 3, 6, 12 and 24 months. Data collected will include sociodemographic information; out of pocket costs; functional outcome; and measures of pain, itch and scarring. Health-related quality of life will be measured using the PedsQL, and impact of injury using the family impact scale. Clinical data and treatment will also be recorded. Around 225 participants will be recruited allowing complete data on around 130 children. Qualitative data collected by in-depth interviews with families, healthcare providers and policymakers will explore the impact of burn injury and outcomes on family life, needs of patients and barriers to healthcare; interviews with families will be conducted by experienced Aboriginal research staff using Indigenous methodologies. Health systems mapping will describe the provision of care. Ethics and dissemination The study has been approved by ethics committees in NSW, SA, NT and Queensland. Study results will be distributed to community members by study newsletters, meetings and via the website; to policymakers and clinicians via policy fora, presentations and publication in peer-reviewed journals.
Working at the interface in Aboriginal and Torres Strait Islander health: focussing on the individual health professional and their organisation as a means to address health equity
(BioMed Central, 2016-11-17) Wilson, Annabelle; Kelly, Janet; Magarey, Anthea Margaret; Jones, Michelle; MacKean, Tamara Jade
Background Aboriginal and Torres Strait Islander people experience inequity in health outcomes in Australia. Health care interactions are an important starting place to seek to address this inequity. The majority of health professionals in Australia do not identify as Aboriginal and/or Torres Strait Islander people and the health care interaction therefore becomes an example of working in an intercultural space (or interface). It is therefore critical to consider how health professionals may maximise the positive impact within the health care interaction by skilfully working at the interface. Methods Thirty-five health professionals working in South Australia were interviewed about their experiences working with Aboriginal people. Recruitment was through purposive sampling. The research was guided by the National Health and Medical Research Council Values and Ethics for undertaking research with Aboriginal communities. Critical social research was used to analyse data. Results Interviews revealed two main types of factors influencing the experience of non-Aboriginal health professionals working with Aboriginal people at the interface: the organisation and the individual. Within these two factors, a number of sub-factors were found to be important including organisational culture, organisational support, accessibility of health services and responding to expectations of the wider health system (organisation) and personal ideology and awareness of colonisation (individual). Conclusions A health professional’s practice at the interface cannot be considered in isolation from individual and organisational contexts. It is critical to consider how the organisational and individual factors identified in this research will be addressed in health professional training and practice, in order to maximise the ability of health professionals to work with Aboriginal and Torres Strait Islander people and therefore contribute to addressing health equity.
Use of telehealth for health care of Indigenous peoples with chronic conditions: a systematic review
(James Cook University, 2017-09-20) Fraser, Sarah; MacKean, Tamara Jade; Grant, Julian; Hunter, Kate; Towers, Kurt; Ivers, Rebecca Q
Introduction: Telehealth may be a cost effective modality in healthcare delivery, but how well used or how appropriate it is for the care of Indigenous peoples is unclear. This review examines the evidence for telehealth in facilitating chronic conditions management with Indigenous peoples. Methods: Databases were systematically searched for qualitative or quantitative primary research studies that investigated telehealth use for chronic conditions management with Indigenous peoples worldwide. Evidence of effectiveness was by consumer health outcomes, evidence of acceptability was through consumer and user perception, and health service feasibility was evident by service impact. Data were assessed for quality and data extracted using pre-defined tools. Results: Articles (n=32) examined effectiveness (n=11), critiqued telehealth from the perspectives of the client (n=10) and healthcare professionals (n=8), and examined feasibility (n=12). Studies reported Indigenous people tend to be satisfied with telehealth, but are sceptical about its cultural safety. Evidence for the effectiveness of telehealth from a western biomedical perspective was found. Conclusions: Telehealth is promising; however, a lack of robust studies in this review make tangible conclusions difficult. A better overall understanding of telehealth use with Indigenous peoples, including delivery of culturally competent health care, true consultation and cultural competency of the professionals involved, would be helpful. Telehealth may have the potential to improve health care for Indigenous people, however the modality needs to be culturally competent and the care received must be culturally safe.
Policy environments and job loss: Lived experience of retrenched Australian automotive workers
(Sage Journals, 2012-09-06) Anaf, Julia Margaret; Newman, Lareen Ann; Baum, Fran; Ziersch, Anna Marie; Jolley, Gwyn
Job loss has negative consequences for health and evidence shows that the agency of workers experiencing job loss is affected by labour market and welfare policy. The policy environment into which workers emerge after losing their jobs strongly influences the way job loss and its aftermath is experienced. This article draws on findings from two waves of in-depth semi-structured interviews with 33 retrenched South Australian automotive workers. It discusses how, within the context of Australian welfare and industrial policy, workers experienced the consequences of mass job losses that occurred at Mitsubishi Motors during 2004 and 2005. Key findings include largely negative experiences associated with negotiating welfare-to-work policy, and a more precarious employment environment further entrenched under industrial relations policy. Job loss is both a personal and a structural story and we use an agency and structure perspective to examine how workers’ agency was enabled, but more often constrained, by policy.
Exploring Social Capital: as Concept and Practice in Australian Public Health Policies and Programs
(Wiley, 2014-04-09) Arthurson, Kathy; Baum, Fran; Ziersch, Anna Marie
Over the past twenty years interest has grown in the concept of social capital in international and Australian public policy. We explore how social capital is understood as a concept and used in practice for guiding policy development and program delivery in South Australian public health programs. The empirical research compared policy makers’ and practitioners’ understandings of social capital and how theories about social capital and health inequality were translated into practice in three case study projects. It found that there are shifting discourses between social capital and related concepts, including community capacity building, and social inclusion/exclusion. Policy makers reported less use of the concept of social capital in favour of social inclusion/exclusion reflecting changing political and policy environments where terms come into favour and then go out of fashion. In this transition period the two terms are often used interchangeably although there are some conceptual points of difference.
Social mix and the role of design: Competing interests in the Carlton Public Housing Estate Redevelopment, Melbourne
(Elsevier, 2014-05-08) Levin, Iris; Arthurson, Kathy; Ziersch, Anna Marie
The social mix policy approach has become a common reaction to the multiple-disadvantage increasingly present in public housing estates in western cities. This approach and its social effects on socially-mixed communities have been studied widely; however the physical form or arrangement of models that such communities are formulated around have been largely missing from this discussion. The importance of design principles as well as the barriers to their implementation in mixed-tenure communities has been largely overlooked. We investigate these factors in a case study of the Carlton Public Housing Estate Redevelopment in Melbourne, Australia, using an analysis of in-depth interviews with public housing tenants, private residents and service providers. The findings show how the implementation of design ‘principles’ was contingent on political and economic decisions made by government and private enterprise stakeholders. Perceptions of whether the physical design of the redevelopment contributed to the lack of successful social mix varied between tenants, government officials, private developers and private residents. We conclude that partly due to the way that economic interests compromised the implementation of preferred design principles undertaken in the Carlton Redevelopment Project (Stage 1), neither housing tenure mix nor social interaction has been successfully experienced by public and private residents in the estate.
Inequalities in social capital and health between people with and without disabilities
(Elsevier, 2014-12-04) Mithen, Johanna; Aitken, Zoe; Ziersch, Anna Marie; Kavanagh, Anne
The poor mental and physical health of people with disabilities has been well documented and there is evidence to suggest that inequalities in health between people with and without disabilities may be at least partly explained by the socioeconomic disadvantage (e.g. low education, unemployment) experienced by people with disabilities. Although there are fewer studies documenting inequalities in social capital, the evidence suggests that people with disabilities are also disadvantaged in this regard. We drew on Bourdieu's conceptualisation of social capital as the resources that flow to individuals from their membership of social networks. Using data from the General Social Survey 2010 of 15,028 adults living in private dwellings across non-remote areas of Australia, we measured social capital across three domains: informal networks (contact with family and friends); formal networks (group membership and contacts in influential organisations) and social support (financial, practical and emotional). We compared levels of social capital and self-rated health for people with and without disabilities and for people with different types of impairments (sensory and speech, physical, psychological and intellectual). Further, we assessed whether differences in levels of social capital contributed to inequalities in health between people with and without disabilities. We found that people with disabilities were worse off than people without disabilities in regard to informal and formal networks, social support and self-rated health status, and that inequalities were greatest for people with intellectual and psychological impairments. Differences in social capital did not explain the association between disability and health. These findings underscore the importance of developing social policies which promote the inclusion of people with disabilities, according to the varying needs of people with different impairments types. Given the changing policy environment, ongoing monitoring of the living circumstances of people with disabilities, including disaggregation of data by impairment type, is critical.
Public housing renewal and social determinants of health
(Taylor & Francis Group, 2016-08-11) Arthurson, Kathy; Levin, Iris; Ziersch, Anna Marie
This article draws on the concept of residential context of housing and its relationship to health. It considers a bundle of changes through implementation of a housing renewal initiative as part of the Carlton Housing Estate Upgrading Project in Melbourne, Australia. Beyond the quality and appropriateness of the housing, pertinent factors explored include social networks, safety and security, and green open space. Data collection for the research project included in-depth interviews with public housing tenants, private residents, and service providers who live on and service the estate, as well as neighborhood observations and participation in on-site events. A key finding was that the relational processes of how tenants were related to by others–specifically, the way housing was reallocated during the processes of renewal–affected social housing tenants’ self-perceived health and well-being.
Support for tenure mix by residents local to the Carlton Housing Estate, Melbourne, Australia
(Taylor & Francis Group, 2017-07-14) Ziersch, Anna Marie; Arthurson, Kathy; Levin, Iris
In this paper, we report on the level of support for tenure mix policies of residents living proximate to the Carlton Housing Estate mixed tenure redevelopment in Melbourne Australia. In a telephone survey of 200 residents living in the area surrounding the estate, the majority of respondents were supportive of tenure mix. Those who were financially comfortable or only spoke English were significantly more supportive than those reporting more difficult financial circumstances or who spoke a language other than English. The reasons for support for tenure mix included avoiding ghettoization, building community and social role modelling. The reasons for opposing tenure mix reflected a concern for the loss of public housing, a view that public and private tenants would not want to be co-located and that public tenants weren’t as deserving as others of living in a good inner city location. There were also concerns from both groups about how tenure mix might work in practice. Policy implications are discussed.
Australian Aboriginal Urban Residents’ Satisfaction with Living in Their Neighbourhood: Perceptions of the Neighbourhood Socio-cultural Environment and Individual Socio-demographic Factors
(Sage Journals, 2011-12-19) Osborne, Katy; Ziersch, Anna Marie; Baum, Fran; Gallaher, Gilbert
This paper draws on survey data from 143 Aboriginal participants living in Adelaide, South Australia, to examine factors associated with Australian Aboriginal urban residents’ satisfaction with living in their neighbourhoods. Associations were examined between neighbourhood satisfaction, individual socio-demographic measures and perceptions of the neighbourhood socio-cultural environment (including experiences of racism in the neighbourhood, perceived tolerance in the neighbourhood, perceived neighbourhood cohesion, trust in other neighbourhood residents and perceived neighbourhood safety). Staged multivariate logistic regression models led to a final model where trust in people in the neighbourhood and perceived safety in the neighbourhood were significant predictors of neighbourhood satisfaction. Experience of racism in the neighbourhood was a significant predictor in earlier steps in the model, but did not remain significant. Understanding factors contributing towards Aboriginal residents’ satisfaction with living in neighbourhoods is important in informing neighbourhood-based policies and programmes to enhance the well-being of Aboriginal residents in Australian cities.
Exploring the Relationship between Housing and Health for Refugees and Asylum Seekers in South Australia: A Qualitative Study
(MDPI, 2017-09-08) Ziersch, Anna Marie; Walsh, Moira; Due, Clemence; Duivesteyn, Emily
Housing is an important social determinant of health; however, little is known about the impact of housing experiences on health and wellbeing for people from refugee and asylum-seeking backgrounds. In this paper, we outline a qualitative component of a study in South Australia examining these links. Specifically, interviews were conducted with 50 refugees and asylum seekers who were purposively sampled according to gender, continent and visa status, from a broader survey. Interviews were analysed thematically. The results indicated that housing was of central importance to health and wellbeing and impacted on health through a range of pathways including affordability, the suitability of housing in relation to physical aspects such as condition and layout, and social aspects such as safety and belonging and issues around security of tenure. Asylum seekers in particular reported that living in housing in poor condition negatively affected their health. Our research reinforces the importance of housing for both the physical and mental health for asylum seekers and refugees living in resettlement countries. Improving housing quality, affordability and tenure security all have the potential to lead to more positive health outcomes. View Full-Text
Workplace bullying and permanent employment in a South Australian working population sample
(Wiley, 2011-11-04) Keuskamp, Dominic; Ziersch, Anna Marie; Baum, Fran; LaMontagne, Anthony D
Objective: We tested the hypothesis that the risk of experiencing workplace bullying was greater for those employed on casual contracts compared to permanent or ongoing employees. Methods: A cross‐sectional population‐based telephone survey was conducted in South Australia in 2009. Employment arrangements were classified by self‐report into four categories: permanent, casual, fixed‐term and self‐employed. Self‐report of workplace bullying was modelled using multiple logistic regression in relation to employment arrangement, controlling for sex, age, working hours, years in job, occupational skill level, marital status and a proxy for socioeconomic status. Results: Workplace bullying was reported by 174 respondents (15.2%). Risk of workplace bullying was higher for being in a professional occupation, having a university education and being separated, divorced or widowed, but did not vary significantly by sex, age or job tenure. In adjusted multivariate logistic regression models, casual workers were significantly less likely than workers on permanent or fixed‐term contracts to report bullying. Those separated, divorced or widowed had higher odds of reporting bullying than married, de facto or never‐married workers. Conclusions: Contrary to expectation, workplace bullying was more often reported by permanent than casual employees. It may represent an exposure pathway not previously linked with the more idealised permanent employment arrangement. Implications: A finer understanding of psycho‐social hazards across all employment arrangements is needed, with equal attention to the hazards associated with permanent as well as casual employment.
Why behavioural health promotion endures despite its failure to reduce health inequities
(Wiley, 2014-02-15) Baum, Fran; Fisher, Matthew
Increasing rates of chronic conditions have resulted in governments targeting health behaviour such as smoking, eating high‐fat diets, or physical inactivity known to increase risk for these conditions. In the process, many have become preoccupied with disease prevention policies focused excessively and narrowly on behavioural health‐promotion strategies. These aim to improve health status by persuading individuals to change their health behaviour. At the same time, health promotion policy often fails to incorporate an understanding of the social determinants of health, which recognises that health behaviour itself is greatly influenced by peoples’ environmental, socioeconomic and cultural settings, and that chronic diseases and health behaviour such as smoking are more prevalent among the socially or economically disadvantaged. We identify several reasons why behavioural forms of health promotion are inadequate for addressing social inequities in health and point to a dilemma that, despite these inadequacies and increasing evidence of the social determinants of health, behavioural approaches and policies have strong appeal to governments. In conclusion, the article promotes strategies addressing social determinants that are likely to reduce health inequities. The article also concludes that evidence alone will not result in health policies aimed at equity and that political values and will, and the pressure of civil society are also crucial.
Evaluation of Health in All Policies: concept, theory and application
(Oxford University Press, 2014-06-01) Baum, Fran; Lawless, Angela Patricia; Delany-Crowe, Toni; MacDougall, Colin James; Williams, Carmel; Broderick, Danny; Wildgoose, Deborah; Harris, Elizabeth; McDermott, Dennis Roy; Kickbusch, Ilona; Popay, Jennie; Marmot, Michael
This article describes some of the crucial theoretical, methodological and practical issues that need to be considered when evaluating Health in All Policies (HiAP) initiatives. The approaches that have been applied to evaluate HiAP in South Australia are drawn upon as case studies, and early findings from this evaluative research are provided. The South Australian evaluation of HiAP is based on a close partnership between researchers and public servants. The article describes the South Australian HiAP research partnership and considers its benefits and drawbacks in terms of the impact on the scope of the research, the types of evidence that can be collected and the implications for knowledge transfer. This partnership evolved from the conduct of process evaluations and is continuing to develop through joint collaboration on an Australian National Health & Medical Research Council grant. The South Australian research is not seeking to establish causality through statistical tests of correlations, but instead by creating a ‘burden of evidence’ which supports logically coherent chains of relations. These chains emerge through contrasting and comparing findings from many relevant and extant forms of evidence. As such, program logic is being used to attribute policy change to eventual health outcomes. The article presents the preliminary program logic model and describes the early work of applying the program logic approach to HiAP. The article concludes with an assessment of factors that have accounted for HiAP being sustained in South Australia from 2008 to 2013.
Dear health minister: tend the garden but make sure you fence the crocodiles
(BMJ Publishing group, 2014-01-02) Baum, Fran; Laris, Paul; Fisher, Matthew; Newman, Lareen Ann; MacDougall, Colin James
This paper offers lessons to in-coming health ministers on how they can act to reduce inequities and take action on social determinants. It draws on an interview study of twenty former Australian State, Territory and Federal health ministers about the extent to which they were able to do these things during their tenure. In order to take effective health equity action the health ministers advised: ensure evidence is used to develop a strong party policy platform for health equity; install policy entrepreneurs for health equity and social determinants in the health ministry; build popular constituencies through processes of deliberative democracy; establish context appropriate cross-department mechanisms to co-ordinate action on social determinants; and be elected in the context of a political party which values social justice and redistribution.

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