Healing Right Way randomised control trial enhancing rehabilitation services for Aboriginal people with brain injury in Western Australia: translation principles and activities.

Background This report provides the theory, method and practice of culturally secure translation and knowledge exchange in the Healing Right Way Clinical Trial (2017-2022), outlining activities to date. Healing Right Way was a stepped wedge cluster randomised controlled trial conducted in Western Australia, aimed at enhancing rehabilitation services and quality of life for Aboriginal Australians following acquired brain injury. The trial translation plan was aspirational and action-oriented, with its implementation iterative and ongoing. Translational activities aimed to inform service and research planning for Aboriginal people with brain injury. Situated in the intercultural space, the work guards against undertaking activities that are monocultural, colonial and appropriating in favour of work that is authentically viewed through the dual lens of whiteness and Aboriginal and Torres Strait Islander ways of knowing, being and doing, and is strengths-based. Methods Three translational and knowledge exchange components were identified, relating to the role of Aboriginal Brain Injury Coordinators, cultural training of hospital staff and the research process itself. Knowledge plans were developed for key audiences, with potential translation products to be monitored for ongoing impact. Results Results demonstrate that translational and knowledge exchange were iteratively embedded throughout the trial life cycle. Data sources included community engagement, partnership meetings and interviews. Activities involved presentations to diverse audiences including bureaucrats, community and participants. Conclusions This report provides a snapshot of the first translation knowledge exchange plan and activities constructed in relation to brain injury rehabilitation services for Aboriginal people. Challenges encountered, as well as successes to date, are discussed.

Relational ethics meets principled practice in community research engagements to understand and address homelessness.

Growing homelessness in Aotearoa New Zealand stems primarily from rising inequalities and poverty. Drawing from scholarship on relational ethics, principled practice and Maori cultural concepts, this paper offers our reflections on nearly two decades of collective work to document and address homelessness. Central to the approach outlined are enduring community partnerships, the cultivation of reciprocal relations, and time spent with homeless people and those trying to work with them. We present exemplars for how we draw on everyday interactions with homeless people and agency staff to enhance local service and broader systemic responses to homelessness.

Healing Right Way: study protocol for a stepped wedge cluster randomised controlled trial to enhance rehabilitation services and improve quality of life in Aboriginal Australians after brain injury.

INTRODUCTION: Despite higher incidence of brain injury among Aboriginal compared with non-Aboriginal Australians, suboptimal engagement exists between rehabilitation services and Aboriginal brain injury survivors. Aboriginal patients often feel culturally insecure in hospital and navigation of services post discharge is complex. Health professionals report feeling ill-equipped working with Aboriginal patients. This study will test the impact of a research-informed culturally secure intervention model for Aboriginal people with brain injury. METHODS AND ANALYSIS: Design: Stepped wedge cluster randomised control trial design; intervention sequentially introduced at four pairs of healthcare sites across Western Australia at 26-week intervals.Recruitment: Aboriginal participants aged ≥18 years within 4 weeks of an acute stroke or traumatic brain injury.Intervention: (1) Cultural security training for hospital staff and (2) local, trial-specific, Aboriginal Brain Injury Coordinators supporting participants.Primary outcome: Quality-of-life using EuroQOL-5D-3L (European Quality of Life scale, five dimensions, three severity levels) Visual Analogue Scale score at 26 weeks post injury. Recruitment of 312 participants is estimated to detect a difference of 15 points with 80% power at the 5% significance level. A linear mixed model will be used to assess the between-condition difference.Secondary outcome measures: Modified Rankin Scale, Functional Independence Measure, Modified Caregiver Strain Index, Hospital Anxiety and Depression Scale at 12 and 26 weeks post injury, rehabilitation occasions of service received, hospital compliance with minimum care processes by 26 weeks post injury, acceptability of Intervention Package, feasibility of Aboriginal Brain Injury Coordinator role.Evaluations: An economic evaluation will determine the potential cost-effectiveness of the intervention. Process evaluation will document fidelity to study processes and capture changing contexts including barriers to intervention implementation and acceptability/feasibility of the intervention through participant questionnaires at 12 and 26 weeks. ETHICS AND DISSEMINATION: The study has approvals from Aboriginal, university and health services human research ethics committees. Findings will be disseminated through stakeholder reports, participant workshops, peer-reviewed journal articles and conference papers. TRIAL REGISTRATION NUMBER: ACTRN12618000139279.

Social and emotional wellbeing, natural helpers, critical health literacy and translational research: connecting the dots for positive health outcomes.

OBJECTIVE: The tripartite framework for principled practice was developed as part of the Wundargoodie Aboriginal Youth and Community Wellbeing Programme. The programme engages natural helpers to enhance critical health literacy. This paper examines the importance of translational research to enhancing critical health literacy for this group of de facto health workers using the work of the Australian Indigenous HealthInfoNet as an example. Translational research provides workforce support for those who are time poor and overburdened. Connecting these concepts and natural helpers will make a positive difference to Aboriginal health outcomes. CONCLUSIONS: There is a need for the development of translational research products that enhance the critical health literacy of natural helpers. The tripartite framework for principled practice supports reflective and accountable practice in the intercultural space to build trust and confidence between Aboriginal and non-Aboriginal people to enhance the opportunity for authentic knowledge production and transfer.

The evolution of epistemology and concepts in an iterative-generative reflective practice: the importance of small differences.

Using a contextualist epistemology, it would be expected that regional differences in community psychology would develop over time. It is argued that the epistemology and theory of Western Australian community psychology, while largely based on North American approaches, has developed its own idiosyncracies. These developed through the integration of practice and theory in an "iterative-generative" fashion. The process of development is conceptualized in terms of Schön's and Altman's distinctions between foundational knowledge, and professional and socially responsive knowledge (I. Altman, 1996; D. A. Schön, 1983). It has also been characterized as an incremental development based on the reflection on tacit and conceptual knowledge. From the small differences that have developed between regions, a dialogue can emerge that will better allow understanding of how social forces shape people's actions.