Equitable systems & policies

Re-Focussing Qualitative Research: Improving the efficacy, rigour and relevance of focus group discussions in Aboriginal health service contexts

Australian Research Council (ARC)
Duration: April 2015 – February 2019 

Background

This research involved an in-depth investigation into the use of Focus Group Discussions (FGDs) in Aboriginal health services research. The aim of this project was to generate knowledge to inform the accountable, culturally appropriate, ethically sound and methodologically rigorous use of FGDs in qualitative Aboriginal health service research.

FGDs are a common way of gathering qualitative data in Aboriginal health services research however there have been no studies on the question of whether they are culturally appropriate research tools, nor are there specific guidelines available to ensure that FGDs are delivered to collect data in ways that are consistent with Aboriginal approaches to consultation, ownership and ways of knowing.

What we did

In Stage 1 of this project we successfully recruited and interviewed researchers who use focus groups as a method and policy makers who utilise qualitative research to inform their policy making practices. Eligible participants were identified from conducting extensive searches of ARC and NHMRC commissioned research, and government websites and organisational charts. Relevant agencies (including the Local Health District, Primary Health Network, NSW Health, Department of Health and Department of the Prime Minister and Cabinet) were contacted to participate. Senior staff and managers with designated roles in Aboriginal health were targeted. Semi-structured interviews were conducted either face-to-face or over the phone over a period of 24 months, from August 2016 to August 2018. A total of 34 interviews were completed with researchers from universities, research institutes or consultant companies/agencies, and 21 policy makers from across departments at local, NSW and Commonwealth levels.

All Stage 1 data were entered and classified in NVivo and qualitative data analysis using framework and thematic approaches were undertaken by multiple members of the research team. The preliminary results of Stage 1 were disseminated via an oral presentation at the Australian Institute of Aboriginal and Torres Strait Islander Studies Conference in Canberra in March 2017, and a poster presentation at the NHMRC-Lowitja Institute Symposium 2017, as well as at the Aboriginal and Torres Strait Islander Studies Conference in Brisbane in July 2019.

For Stage 2, Listening to Aboriginal Voices, ethical approval was obtained in June 2016 following discussions with CEOs of several Aboriginal Medical Services in NSW. Recruitment of organisations and participants to Stage 2 continued into early 2018. Two focus groups were conducted with 15 Aboriginal community participants, and a further 13 in-depth interviews were conducted with staff of Aboriginal Community Controlled Health Organisations (ACCHOs). Results from Stage 2 were disseminated at the NHMRC Symposium on Research Translation in November 2018 in Sydney and at the European Congress of Qualitative Inquiry in Edinburgh in February 2019.

The major activity for Stage 3 of the project was the hosting of a Knowledge Exchange Forum at the University of Technology, Sydney in October 2018. The workshop brought together stakeholders, researchers, Aboriginal community members, and ACCHOs to engage in a knowledge exchange forum and facilitate the development of a model with culturally effective guidelines and resources for focus group discussion research in Aboriginal health services. The aim of the Knowledge Exchange Forum was to develop a comprehensive, evidence-informed framework for appraising, designing and undertaking focus group discussion research in Aboriginal health service delivery contexts and guidance on associated training; and explore the feasibility of applying such a framework.

Research activities are completed, with the project concluding in early 2019. A key outcome from the research is a model for how focus groups research in health services can be conducted, analysed, disseminated and utilised in a way that is consistent with Aboriginal ways of being, knowing and doing.

Systemic Entrapment

October 2019 - October 2020

Background

This project seeks to deconstruct, undermine, while also understand the association with the multiple interactions and multigenerational experiences, across governmental systems that maintain First Nations Peoples oppression. In Franz Fanon’s book, The Wretched of the Earth, the phrase ‘cause is the consequence’ provides a rhetorical lens to understand the containing and condemning of historically and racially oppressed peoples within systems and structures. Informed by these writings we use the term systemic entrapment, to describe the ways in which First Nations Peoples experience ongoing colonisation and continue to be controlled and contained under various laws and legislative regimes. Systemic entrapment links pathways of contact with multiple governmental institutions such as education, employment, child protection, health, juvenile justice and the criminal justice system. This is in addition to deconstructing experiences of racial profiling to better understand the ways in which poverty is and can be criminalised. This work will assist to advance Indigenous Research Methodologies through an emancipative and critical theory lens, considering approaches from the Western academic system blended within an Aboriginal paradigm.

Specifically, the project brings together current knowledge and expert advice in order to explore what is required to identify where and how systemic entrapment occurs and how it functions to continually oppress First Nations Peoples. For practical purposes, we draw on our extensive networks of practitioners working within South Eastern New South Wales which can be seen as a microcosm of Australian society.

What we did

The project consists of three outcome areas. The first is a literature and policy review to: Identify factors with First Nations Peoples association with governmental systems; and Assess the inclusion of Human Rights guidelines in policy and legislation, such as the Bangkok Rule, Universal Declaration of Indigenous Human Rights, Universal Human Rights of the Child.

Secondly, we will host a series of round tables with frontline staff from Aboriginal Organisations and Government agencies from the South Eastern NSW Region to: Describe the factors that staff identify as impacting First Nations People’s association with state systems, including the enablers and inhibitors;  unpack the intersectional factors such as race, gender expression, class, social economic status, sexuality, ableism, which can increase vulnerabilities to maintain a connection within various systems and structures; and  assess participants understanding of Human Rights guidelines in development of policy and legislation.

The final outcome is to bring together the team of researchers to: deliver a seminar on State, National and International perspectives and experiences of systemic entrapment from Australia and elsewhere and develop a grant application for external funding.

All three outcome areas are currently underway.

Observing the research-policy nexus: an ethnographic study of research use in Indigenous health policy

Duration: 2015—2020 (expected completion)
Funding: Australian Government Research Training Program Scholarship (RTP)
PhD candidate: Joanna Mason

Background

Evidence-based policy making has become ubiquitous in Australia in recent years. In common with government administrations worldwide, it is upheld as the solution for irrationality and political influence over policy and decision making. It promises instead to prioritise ‘what works’ in policy design and delivery, yet the desirability and the success of this is frequently questioned and debated. Expectations for evidence use are often based on simplistic understandings of research to policy transfer, with few perspectives drawn from empirical and ‘insider’ investigation into the daily practices and processes of policy making. These perspectives commonly fail to take into account what are genuine efforts for policy makers to take heed of research within the constraints and the realities of the policy setting.

What we did

This study explores the ways that research and evidence are used by policy actors, and the implications of this for the evidence-based policy and research impact agendas. Investigated through dual roles of participant and observer, the practice of policy making is studied through the lens of policy actors as bureaucratic community and socio-cultural system. Utilising an anthropological and ethnographic approach, this study is a rich narrative of the nexus between research and policy from the position of policy actor.

The fieldwork component of this study was conducted in 2018-19 within the Australian Public Service – at a sub-division of a department who develop policies and programs to redress the poor health and wellbeing outcomes of Australia’s Indigenous peoples.

Aboriginal Community Controlled Health Organisations research and evaluation project (Phase 2)

Coordinare Primary Health Network, South Eastern NSW
Duration: October 2018 – October 2019 

Background

This project involved Ngarruwan Ngadju researchers working collaboratively with Aboriginal Community Controlled Health Organisations (ACCHOs) in south-eastern NSW on the development and implementation of a community based participatory evaluation and research program, aimed at enhancing the research and evaluation capacity of the participating organisations. This project built on and extended our previous capacity building project by focusing on effective collection, analysis and utilisation of health service data within the regional ACCHOs.

What we did

The project had four main components. Firstly, we identified the ways in which health service data is currently collected and utilised by the services and the systems to capture and report on data. Secondly, worked with staff responsible for data capture and analysis and assisted with capacity building training. Thirdly, we provided assistance to services to improve data collection and reporting on particular projects. Finally, we conducted a series of face to face training workshops. Workshop delivered in 2019 were: Introduction to Indigenous Research Methodology; Demystifying quantitative data using visualisation; Yarning as a research method; Tools for evaluation: Using logic models and frameworks to evaluate holistic programs; Recording, analysing and writing using narrative and ethnographic approaches; and Writing grants and submissions - collaborative writing for publication.

Improving cultural diversity in corporate Australia: embedding Indigenous employment strategies into policy and procedures

PhD Project, Faculty of Business and Law
PhD candidate: Nyssa Murray

Background

The aim of this project is to review the human resource management systems (HRMS) and identify key variables that impact Indigenous employment in corporate Australian organisations. The study will utilise systems theory, augmented with Indigenous research methodologies, to understand the current state and influence design of human resource management policies and procedures that can lead to improved cultural diversity. This project will take a full view of the HRMS in order to develop a cultural interface that can re-describe terms of Indigenous knowledge and western knowledge from each other’s perspective that will essentially help non-Indigenous managers to better understand cultural knowledge. Furthermore, it will allow for a shift in employee perceptions, cultural understanding and acceptance, and overall improved retention rate.

This is an exploratory project that uses mixed methods and is driven by creating a cultural shift that will benefit improved understanding of cultural differences in organisational settings. The research questions are:

1. What are the key variables of a human resource management system that can contribute to creating change for Indigenous Australian employees and increase Indigenous employment outcomes?
2. What are the lived experiences of Indigenous and non-Indigenous individuals in large organisations in Australia and how can we apply learning from these experiences to improve diversity in corporate Australia?
3. What are the intended and unintended consequences of embedding Indigenous employment strategies (culture) into everyday human resource management policy and procedures?
4. What are the impacts of a participative framework embracing a subtle cultural interface?

What we did

To achieve the aims of the study, the key research objectives are to:

• Undertake a broad literature and policy review
• Critically review the business process models employed by large corporate organisations in order to ‘untangle’ the complexity of human resource management systems
• Identify factors (social, cultural, economic) that impact on the attraction, recruitment, retention and professional development of indigenous people
• Build a simulation model (policies and procedures) that will embed cultural knowledge and understanding to assist non-Indigenous managers for decision making.

An initial literature review has been undertaken and ethical approval for the research has been obtained from the University of Wollongong Human Research Ethics Committee. The active data collection phase is underway.

Understanding trauma and burn patient transfer processes, patient experiences and models of care for Aboriginal and Torres Strait Islander children in Emergency Departments in New South Wales

January 2018 - December 2019

Background

Aboriginal and Torres Strait Islander children are over-represented in serious injury compared with other Australian children. The rates of injury increase with increasing remoteness. Further, the timeliness of treatment in Emergency Departments (ED) and access to services and care appears to be different for Aboriginal and Torres Strait Islander people. Despite the large burden of serious injury for Aboriginal and Torres Strait Islander children, very little is known about the child’s first presentation to hospital, specifically, how is the child assessed, what factors are considered when deciding if and when a child should be transferred and importantly, how do families perceive the care their children are given and how do service providers perceive that care delivery? The objective of this study is to better understand the factors associated with care delivery for Aboriginal and Torres Strait Islander children who present to NSW EDs.

What we did

The study aims to: describe Aboriginal and Torres Strait Islander children’s trauma and burns related presentations to Emergency Departments across New South Wales; explore Aboriginal and Torres Strait Islander families’ perceptions of the treatment and care received at NSW EDs; and understand clinician’s and service provider’s considerations when treating an Aboriginal and Torres Strait Islander child who presents to an ED following trauma or burns.

This study has 5 phases: literature review, review of ED trauma data, qualitative in-depth interviews with families, interviews with clinicians and service providers, review of ED models of care. The study is advised by an Advisory Committee comprising of representatives from local Aboriginal Community Controlled Organisations and NSW Health and relevant peak bodies.

The initial phases of the study have been completed and the study results are being written up.

National Injury Prevention Strategy - Literature Review

January 2019 - May 2019

Background

The National Injury Prevention Strategy (Strategy) is a 2018-19 Budget measure to be developed over 2018-19 to 2019-20. The Strategy will update and build on the National Injury Prevention Plan 2004-2014. It will provide a policy platform to support interventions that reduce the risk of injury amongst the Australian population taking a whole of population and all-ages approach. Vulnerable groups including children and Aboriginal and Torres Strait Islander people will be a specific focus.

What we did

A review of the published and grey literature on injury prevention underpinned by the latest Burden of Disease literature was undertaken to: Identify evidence-based injury prevention priorities; identify ‘best buys’ (cost-effective, good return on investment, good quality) injury prevention interventions that could be done nationally in Australia or as smaller try, test, learn pilot projects; identify current barriers and gaps in injury prevention in Australia; identify current funding and legal levers in Australia; and identify existing injury prevention priorities and action plans from current strategies, frameworks and plans. The outcome will be to provide evidence on which to base National Injury Prevention Strategy priorities and action plans.

Publication

Hunter K., Bestman A., Keay L., Clapham K, Scott D, Killian J, Curtis K, Cullen P, Ivers RQ, Beck B, Vallmuur K, Mitchell R, Lukaszyk C, Brown J. National Injury Prevention Strategy – Literature Review. (Draft One March, 2019). Report developed for the Australian Government Department of Health.

National Injury Prevention Strategy

June 2019 - June 2020

Background

The National Injury Prevention Strategy (Strategy) is a 2018-19 Budget measure to be developed over 2018-19 to 2019-20. The Strategy will update and build on the National Injury Prevention Plan 2004-2014. It will provide a policy platform to support interventions that reduce the risk of injury amongst the Australian population taking a whole of population and all-ages approach. Vulnerable groups including children and Aboriginal and Torres Strait Islander people will be a specific focus.

What we did

Ngarruwan Ngadju is working with a consortia of Consortia researchers from various universities, under the leadership of The George Institute for Global Health which has been contracted by the Commonwealth Government to produce an evidence-based National Injury Prevention Strategy developed with wide consultation. A Literature Review has been completed and a series of Round Tables of key stakeholders undertaken to scope the Strategy and identify the priorities and action plans to be included. The team is working actively with the Expert Advisory Group (EAG) on the development of the Strategy.

Review of the Integrated Team Care PHN program in South Eastern NSW

COORDINAIRE
March 2020 - February 2021

Investigators: 

• Professor Kathleen Clapham, University of Wollongong (Lead CI)
• Associate Professor Peter Malouf, University of Sydney
• Dr Christine Metusela, University of Wollongong

Background

The key objective of this project is to define an equitable funding and resource allocation model to suit regional requirements consistent with Integrated Team Care (ITC) National Guidelines.

Programs such as ITC access, engage with, deliver Aboriginal services, and provide leadership and capacity building opportunities, all of which are critically important to local Aboriginal communities. There is an opportunity to review how the ITC program has been delivered locally in South Eastern New South Wales (SENSW) and understand where there are areas for improved alignment.

The project works in partnership with the Aboriginal Community Controlled Health Services (ACCHS) and a main stream service provider across SENSW. The research will apply a decolonising lens to:

• Evaluate the service delivery of the ITC model across SENSW and assess the strengths and limitations of the current model.
• Co-design a regional collaborative model of coordinated care. This will include recommendations for best use of funding and resources to deliver against program guidelines, and suggestions for how COORDINARE will measure the effectiveness of proposed recommendations.