Acting locally, thinking nationally: layering Indigenous ontology within wellbeing frameworks.

There are hundreds of sovereign nations covering the modern nation-state of Australia.1 Noting the inadequacy of many contemporary terms to encompass Indigenous ontology, Indigenous nations have long practised what is now being expressed as 'wellbeing frameworks' in many nation-states. Unlike the sentiment expressed in contemporary wellbeing frameworks, Country - the complex web of relationships between the human and other-than-human that underpins everything2 - and relationality are fundamental to Indigenous 'wellbeing'. The philosophy of mabu liyan (good feeling), intrinsic to the Yawuru nation of North Western Australia, is only one example of Indigenous governance where Country-centred planning and relational wellbeing are 'business as usual'. Layering elements that are critical to Indigenous expressions of wellbeing, specifically Country and relationality, when developing wellbeing frameworks would broaden and deepen contemporary approaches to wellbeing while accommodating differences at the local scale.

Relationship of Aboriginal family wellbeing to social and cultural determinants, Central Australia: 'Waltja tjutangku nyakunytjaku'.

OBJECTIVE: The objective of this study was to apply a strength-based approach to examine the relation of cultural and social determinants to high family functioning for Aboriginal people in Central Australia. DESIGN: Cross-sectional study involving a quantitative analysis of survey data. Prevalence rate ratios (PRs) and 95% CIs were calculated from binomial regressions, adjusted for gender and age. Qualitative data from workshops with Aboriginal leaders in Central Australia supported the interpretation of the research findings. PARTICIPANTS: The study involved 639 Aboriginal people in Central Australia who participated in the Mayi Kuwayu Study. RESULT: Overall, 57.9% (370/639) of participants reported high/very high family functioning, 16.9% (108/639) reported moderate and 13.3% (85/639) reported low. The adjusted prevalence of family functioning was similar across gender, age groups and household sizes. Family functioning was associated with lower family financial status (aPR=0.74, 95% CI=0.60 to 0.91) and receiving welfare (0.88, 0.77 to 1.00). Family functioning was greater with high community cohesion (2.72, 1.68 to 4.39), high individual agency in community (2.15, 1.63 to 2.85); having an Aboriginal language as a first language (1.20, 1.04 to 1.37); speaking your Aboriginal language a lot (1.37, 1.12 to 1.68); high exposure to cultural practice and knowledge (1.45, 1.28 to 1.65); and multigenerational or extended family households (1.19, 1.02 to 1.38). CONCLUSION: High family functioning is a strength in Central Australia and is intrinsically connected with culture. Healthcare providers and programmes that build on the foundations of culture and family are an important approach to improving wellbeing.

Community-based social care models for indigenous people with disability: A scoping review of scholarly and policy literature.

Disability is experienced and understood by Indigenous people internationally in distinct ways from other populations, requiring different approaches in disability services. Furthermore, Indigenous populations access disability services at low rates. In response, policymakers, service providers and Indigenous organisations have developed specific models of care for Indigenous people with disability. Social care services, comprising personal care, transport and social activities, can support Indigenous people with disability to live with their families and in their communities. However, little is known about the range of social care models for Indigenous people with disability. To inform policy and practice, we conducted a scoping review of community-based models of social care designed to meet the needs of Indigenous peoples in Australia, Aotearoa New Zealand, Canada and the United States. Our methods were informed by best practice scoping review principles and a collaborative approach that centred Indigenous voices within research appraisal and project governance processes. Literature searches (conducted March-April 2021) yielded 25 results reporting on 10 models of care. We identified two over-arching themes (funding and governance arrangements; service delivery design) that encompass nine key characteristics of the included models. Our analysis shows promising practice in contextually relevant place-based social activity programs, support and remuneration for family carers and workforce strategies that integrate Indigenous staff roles with kinship relationships and social roles. While more research and evaluation are needed, disability funding bodies and service systems that facilitate these areas of promising practice may improve the accessibility of social care for Indigenous peoples.

Towards the decolonisation of disability: A systematic review of disability conceptualisations, practices and experiences of First Nations people of Australia.

In many settler-colonial countries, Indigenous people do not access disability services at rates commensurate with disability prevalence. Existing research suggests that services often do not reflect Indigenous values and social practices, impacting on accessibility. Furthermore, disability services have historically been implicated in processes of colonisation. There is an urgent need to decolonise disability services. Understanding Indigenous knowledge and experience of disability is a necessary step towards achieving this. We systematically reviewed the disability conceptualisations, practices and experiences of First Nations peoples of Australia. Twelve studies met inclusion criteria. There was a consensus among these studies that Western constructs of disability do not resonate with many First Nations people across Australia. The studies reported that many First Nations people conceptualise most disabilities as unremarkable conditions that reflect the normal range of human diversity, although some conditions may be associated with social stigma. Inclusive attitudes and practices of caregiving in First Nations families facilitate the participation of First Nations people with disabilities in family and community life. However, ableism and racism in broader society combine to exclude many First Nations peoples with disabilities from public spaces and from labour markets. Disability services regularly fail to reflect First Nations values and social practices, and can lead to further disempowerment and marginalisation due to diagnostic processes; displacement from country and communities; gendered discrimination; and poor relationships with service providers. We argue that intersectional experiences of colonialism, racism, ableism and sexism, particularly in disability services, can lead to the marginalisation of First Nations participants and families. The decolonisation of disability services requires services to embrace diverse First Nations values and practices associated with human capability, social participation and caregiving. Decolonising disability services also necessitates First Nations control of the governance of disability services and reform across service, organisational, systemic and conceptual levels.

Examining the Associations between Indigenous Rangers, Culture and Wellbeing in Australia, 2018-2020.

The centrality of culture to Indigenous peoples' health and wellbeing is becoming increasingly acknowledged in government policy. In Australia, the Indigenous Ranger program is a leading example of employment that supports increased cultural participation. In 2017, we demonstrated higher life satisfaction and family wellbeing among Indigenous Rangers compared to non-Rangers in Central Australia. Using an expanded national dataset, this present study aimed to: examine if associations between Ranger status and wellbeing continued to be observed in Central Australia; assess if these associations were observed among non-Central Australian Rangers; and, quantify the effect of mediating variables (Rangers status, cultural factors) on wellbeing outcomes. We analyzed Mayi Kuwayu baseline data (n = 9691 Aboriginal and Torres Strait Islander people) and compared participants who identified as past or currently employed Rangers compared to non-Rangers across two geographic locations (Central Australia, non-Central Australia). Ranger participation was significantly associated with very high life satisfaction and family wellbeing in Central Australia (high life satisfaction PR 1.31, 95% CI 1.09-1.57, and family wellbeing (PR 1.17, 95% CI 1.01-1.36) and non-Central Australia (high life satisfaction PR 1.29, 95% CI 1.06-1.57), family wellbeing (PR 1.37, 95% CI 1.14-1.65). These findings concord with those observed in the 2017 proof-of-concept study. Additionally, we found that Ranger status partially mediated the relationships between existing cultural practices (first language as your Indigenous language and living on your country) and the two wellbeing outcomes. Current cultural practices, spending time on country and speaking your Aboriginal language, also partially mediated the associations between Ranger status and high life satisfaction, and between Ranger status and high family wellbeing. This analysis supports evidence that both Ranger employment and cultural participation are contributors to wellbeing. Ranger work is not only good for land, but it is good for people. As such, determining policies that mutually acknowledge and enhance culture, health and wellbeing will likely have additional benefits for the broader Aboriginal and Torres Strait Islander population.

Roadmap to recovery: Reporting on a research taskforce supporting Indigenous responses to COVID-19 in Australia.

In April 2020 a Group of Eight Taskforce was convened, consisting of over 100 researchers, to provide independent, research-based recommendations to the Commonwealth Government on a "Roadmap to Recovery" from COVID-19. The report covered issues ranging from pandemic control and relaxation of social distancing measures, to well-being and special considerations for vulnerable populations. Our work focused on the critical needs of Aboriginal and Torres Strait Islander communities; this paper presents an overview of our recommendations to the Roadmap report. In addressing the global challenges posed by pandemics for citizens around the world, Indigenous people are recognised as highly vulnerable. At the time of writing Australia's First Nations Peoples have been largely spared from COVID-19 in comparison to other Indigenous populations globally. Our recommendations emphasise self-determination and equitable needs-based funding to support Indigenous communities to recover from COVID-19, addressing persistent overcrowded housing, and a focus on workforce, especially for regional and remote communities. These latter two issues have been highlighted as major issues of risk for Indigenous communities in Australia It remains to be seen how governments across Australia take up these recommendations to support Indigenous peoples' health and healing journey through yet another, potentially catastrophic, health crisis.

Who responds? An examination of response rates to a national postal survey of Aboriginal and Torres Strait Islander adults, 2018-2019.

BACKGROUND: Evidence on the effectiveness of postal recruitment methods for Indigenous peoples is lacking. Mayi Kuwayu, the National Study of Aboriginal and Torres Strait Islander Wellbeing, uses multi-staged sampling. We aimed to test postal surveys as a primary recruitment method, analysing preliminary response rate data to inform the Study's ongoing sampling approach. METHODS: Twenty thousand adults aged ≥16 years were sampled from Aboriginal and Torres Strait Islander people enrolled in the Medicare Australia Enrolment Database. We calculated response rates at 4 and 15 weeks, overall and by age group, gender, state/territory and remoteness. RESULTS: The overall response rate was 2.3% (n = 456/20000). Highest response rates were observed among males and females ≥50 years from major cities (6.0, 95%CI 4.4-7.9 and 5.5%, 4.1-7.2, respectively) and regional areas (6.0%, 4.6-7.6 and 6.2%, 4.9-7.7, respectively). Younger age groups and remote areas had lower response rates; all remote age groups < 50 years had a response rate ≤ 0.6%. While most participants responded on the paper surveys, online responses were more common among younger age groups and, respondents with higher education levels and whose first language was not English. CONCLUSION: Using a postal survey, we observed response rates of ≥5.5% among older Aboriginal and Torres Strait Islander adults in major cities and regional areas; response rates were lower in other groups. A two-stage postal distribution approach provided an opportunity to adapt sampling approaches to different demographic groups. Based on initial response rates, the sampling strategy was revised to send postal surveys to groups with higher response rates groups and focus field recruitment strategies on low response groups.