Objective: Routine inquiry has been introduced in many health settings to identify women who are ... more Objective: Routine inquiry has been introduced in many health settings to identify women who are experiencing intimate partner violence (IPV). A range of validated tools exist; however, little attention has been given to how health professionals interpret women’s responses and whether they align with women’s own perceptions about whether they disclosed abuse. Method: This qualitative synthesis was undertaken in eight Australian antenatal clinics over 14 months. We invited women in waiting areas to participate in an anonymous interview about antenatal assessment, to identify those with past year IPV and their recollections of disclose abuse to midwives. Accounts were compared with file review data from antenatal records. Focus groups conducted at each site with midwives explored these findings. Results: Eleven Aboriginal and 32 non-Aboriginal antenatal patients who had experienced abuse were interviewed and files reviewed. IPV disclosures were often not recorded in clinical notes, despite protocols for asking and documenting. Of the 43 women, 30 (70%) reported they had disclosed their abuse in response to screening and 13 (30%) reported they did not disclose. Of the 30 who disclosed, only 16 (53%) antenatal records documented a disclosure. Qualitative analysis of patient interviews and focus group discussions with midwives identified two key themes: (a) women’s responses to screening questions were rarely “yes” or “no” and (b) midwives were often unclear whether women’s responses constituted IPV. Conclusions: Screening tools are needed, which recognize that IPV is not a binary construct and support health professionals to interpret women’s responses. (PsycInfo Database Record (c) 2021 APA, all rights reserved
The prevalence of diabetes among Aboriginal and Torres Strait Islander (hereafter 'Aboriginal... more The prevalence of diabetes among Aboriginal and Torres Strait Islander (hereafter 'Aboriginal') Australians is three times greater than non-Aboriginal Australians, contributing to a greater risk of blindness from treatable and preventable ocular conditions, most prominently cataract and diabetic retinopathy. In rural and remote Aboriginal communities, blindness prevalence is higher, and ocular treatment coverage and uptake are lower. In collaboration with Aboriginal Community Based Researchers (CBRs), this study explored complex contingent factors that shape access to eye health services among rural and remote Aboriginal Australians living with diabetes. Interviews (n = 126) and focus groups (n = 12) were conducted with patients, primary care clinicians, and CBRs, in four rural communities in the Northern Territory and New South Wales. Factors internal and external to health systems were examined, drawing on Bourdieu's concepts of habitus, and doxa to understand agency and decision-making among patients and clinicians. The study used the ontology of critical realism, categorising contingent factors as underlying structures (generative mechanisms), and applying a decolonising approach that centred causal relationships and tensions between dominant (Western biomedical neoliberalism) and non-dominant (Aboriginal) value systems. Three forms of marginalisation; linguistic, economic, and cultural, were identified as the generative mechanisms that inhibit equitable eye health outcomes. Marginality is linked to structural factors that position Aboriginal culture as a barrier, and is reinforced through biomedical health systems, and the agents who operate in and influence them. In order to address eye health inequity, a shift in how Aboriginal cultural sovereignty is understood within health systems is needed, to position it as a strength that can facilitate eye care accessibility, and to support enhanced cultural responsivity among clinicians and service providers.
Evidence of sexual violence against men and boys in many conflict-affected settings is increasing... more Evidence of sexual violence against men and boys in many conflict-affected settings is increasingly recognized. Yet relatively little is currently known about the varied forms, sites, and impacts of this violence. Further, scant research on sexual violence against men and boys in displacement contexts has been undertaken to date. To begin to address these knowledge gaps, we undertook a multicountry, qualitative, exploratory study to gain insights into these issues. Study settings and populations were Rohingya refugees in Bangladesh; refugees and migrants who had traveled through Libya residing in Italy; and refugees from eastern Democratic Republic of the Congo (DRC), Somalia, and South Sudan residing in Nairobi and Mombasa, Kenya. Methods included 55 semi-structured focus group discussions with 310 refugees and semi-structured key informant interviews with 148 aid workers and human rights experts. Data were thematically analyzed using NVivo 12. Findings suggest that sexual violence...
Objective: Routine inquiry has been introduced in many health settings to identify women who are ... more Objective: Routine inquiry has been introduced in many health settings to identify women who are experiencing intimate partner violence (IPV). A range of validated tools exist; however, little attention has been given to how health professionals interpret women’s responses and whether they align with women’s own perceptions about whether they disclosed abuse. Method: This qualitative synthesis was undertaken in eight Australian antenatal clinics over 14 months. We invited women in waiting areas to participate in an anonymous interview about antenatal assessment, to identify those with past year IPV and their recollections of disclose abuse to midwives. Accounts were compared with file review data from antenatal records. Focus groups conducted at each site with midwives explored these findings. Results: Eleven Aboriginal and 32 non-Aboriginal antenatal patients who had experienced abuse were interviewed and files reviewed. IPV disclosures were often not recorded in clinical notes, despite protocols for asking and documenting. Of the 43 women, 30 (70%) reported they had disclosed their abuse in response to screening and 13 (30%) reported they did not disclose. Of the 30 who disclosed, only 16 (53%) antenatal records documented a disclosure. Qualitative analysis of patient interviews and focus group discussions with midwives identified two key themes: (a) women’s responses to screening questions were rarely “yes” or “no” and (b) midwives were often unclear whether women’s responses constituted IPV. Conclusions: Screening tools are needed, which recognize that IPV is not a binary construct and support health professionals to interpret women’s responses. (PsycInfo Database Record (c) 2021 APA, all rights reserved
The prevalence of diabetes among Aboriginal and Torres Strait Islander (hereafter 'Aboriginal... more The prevalence of diabetes among Aboriginal and Torres Strait Islander (hereafter 'Aboriginal') Australians is three times greater than non-Aboriginal Australians, contributing to a greater risk of blindness from treatable and preventable ocular conditions, most prominently cataract and diabetic retinopathy. In rural and remote Aboriginal communities, blindness prevalence is higher, and ocular treatment coverage and uptake are lower. In collaboration with Aboriginal Community Based Researchers (CBRs), this study explored complex contingent factors that shape access to eye health services among rural and remote Aboriginal Australians living with diabetes. Interviews (n = 126) and focus groups (n = 12) were conducted with patients, primary care clinicians, and CBRs, in four rural communities in the Northern Territory and New South Wales. Factors internal and external to health systems were examined, drawing on Bourdieu's concepts of habitus, and doxa to understand agency and decision-making among patients and clinicians. The study used the ontology of critical realism, categorising contingent factors as underlying structures (generative mechanisms), and applying a decolonising approach that centred causal relationships and tensions between dominant (Western biomedical neoliberalism) and non-dominant (Aboriginal) value systems. Three forms of marginalisation; linguistic, economic, and cultural, were identified as the generative mechanisms that inhibit equitable eye health outcomes. Marginality is linked to structural factors that position Aboriginal culture as a barrier, and is reinforced through biomedical health systems, and the agents who operate in and influence them. In order to address eye health inequity, a shift in how Aboriginal cultural sovereignty is understood within health systems is needed, to position it as a strength that can facilitate eye care accessibility, and to support enhanced cultural responsivity among clinicians and service providers.
Evidence of sexual violence against men and boys in many conflict-affected settings is increasing... more Evidence of sexual violence against men and boys in many conflict-affected settings is increasingly recognized. Yet relatively little is currently known about the varied forms, sites, and impacts of this violence. Further, scant research on sexual violence against men and boys in displacement contexts has been undertaken to date. To begin to address these knowledge gaps, we undertook a multicountry, qualitative, exploratory study to gain insights into these issues. Study settings and populations were Rohingya refugees in Bangladesh; refugees and migrants who had traveled through Libya residing in Italy; and refugees from eastern Democratic Republic of the Congo (DRC), Somalia, and South Sudan residing in Nairobi and Mombasa, Kenya. Methods included 55 semi-structured focus group discussions with 310 refugees and semi-structured key informant interviews with 148 aid workers and human rights experts. Data were thematically analyzed using NVivo 12. Findings suggest that sexual violence...
The alarming prevalence of diabetes among the adult Australian Indigenous population (37% >55 yea... more The alarming prevalence of diabetes among the adult Australian Indigenous population (37% >55 years) (ABS, 2013) has subsequently raised the risk and prevalence of diabetic visual impairment (Taylor, 2009). Issues around prevention and access to care continue to support disparities in health equity between the Indigenous and non-Indigenous population in Australia.
Using a qualitative, action research design, we aim to understand how human experiences and the social determinants which shape them, impact equity in eye health, for Indigenous Australians living with diabetes in remote communities. Results of the study were reported back to ACCHS with an aim to strengthen primary eye care systems and improve quality and access to eye care for Indigenous Australians.
Semi-structured interviews (n=82) and focus groups (n=8) were conducted by Indigenous Community Based Researchers (CBRs) (TF, WF, KB, GB, FH, RS, BD, BJ) with Indigenous adults (>40 years) living with diabetes in 4 remote communities in Australia. Interviews were audio recorded and transcribed verbatim. Data was analysed thematically using grounded theory and Nvivo 10. Analysis occurred in tandem with data collection to determine theoretical saturation. The principal investigator (AY) led analysis sessions with CBRs, fostering cultural appropriateness, knowledge exchange and capacity building.
Overall participants had poor knowledge of diabetic eye diseases including risk of permanent vision loss, prevention and treatment. Participants understood diabetic eye disease through physical symptoms such as blurriness; and linked this to poor diet, use of medication or the need for spectacles. Fear and distrust of mainstream services was a notable barrier to care. Participants engaged in routine diabetes management had better knowledge of risks, prevention and treatment. Social determinants including cultural inequity/post colonialism, economic background and education were found to heavily impact an Indigenous Australian's capability to access appropriate care and adequately manage diabetes.
The findings of this study may be used to develop Indigenous community driven health promotion materials targeting the gap in knowledge around risk, prevention and treatment of diabetic eye diseases. Embedding screening for diabetic eye diseases into routine primary care and chronic disease management may help increase knowledge of prevention among Indigenous patients as well as early detection.
Research is an important part of understanding the complexities of health in equity, and has been... more Research is an important part of understanding the complexities of health in equity, and has been identified nationally as crucial in building effective evidence based practice and policy in Aboriginal and Torres Strait Islander (Aboriginal) health. In recent times, approaches to Aboriginal health research have shifted to reflect the role of Aboriginal knowledge, participation and collaboration as integral to its conduct. This poster presents the protocol for a systematic meta-narrative review, which will identify empirical studies that have encouraged the participation of Aboriginal communities and included the perspectives and experiences of Aboriginal people (including patients, carers, family, community members) in research related directly to Aboriginal health. The review will provide a foundation to one authors’ (AY) PhD, a participatory action research study which is investigating the way Aboriginal patients experience eye care services in the N.T and NSW, Australia, and how this relates to clinical journeys and outcomes, social determinants and health equity. The study as a whole aims to apply findings and recommendations gathered through qualitative interviews with community members and health staff directly into Continuous Quality Improvement (CQI) measures and training through the overarching Vision CRC project. The importance of the review and where it sits within the wider study, processes and methodology will be presented. All sampled literature gathered in this review will be collated and analysed using meta-narrative methodology, creating a fuller picture of current evidence. This approach was chosen so that differences and commonalities in conceptualisation, theoretical approaches and empirical findings may be examined across the wide spectrum of research traditions involved in Aboriginal health. The findings of this review will provide important and useful evidence for those working in the Aboriginal health sector, and contribute towards a deeper understanding of ‘best practice’ in Aboriginal health research.
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Papers by Anthony Zwi
Using a qualitative, action research design, we aim to understand how human experiences and the social determinants which shape them, impact equity in eye health, for Indigenous Australians living with diabetes in remote communities. Results of the study were reported back to ACCHS with an aim to strengthen primary eye care systems and improve quality and access to eye care for Indigenous Australians.
Semi-structured interviews (n=82) and focus groups (n=8) were conducted by Indigenous Community Based Researchers (CBRs) (TF, WF, KB, GB, FH, RS, BD, BJ) with Indigenous adults (>40 years) living with diabetes in 4 remote communities in Australia. Interviews were audio recorded and transcribed verbatim. Data was analysed thematically using grounded theory and Nvivo 10. Analysis occurred in tandem with data collection to determine theoretical saturation. The principal investigator (AY) led analysis sessions with CBRs, fostering cultural appropriateness, knowledge exchange and capacity building.
Overall participants had poor knowledge of diabetic eye diseases including risk of permanent vision loss, prevention and treatment. Participants understood diabetic eye disease through physical symptoms such as blurriness; and linked this to poor diet, use of medication or the need for spectacles. Fear and distrust of mainstream services was a notable barrier to care. Participants engaged in routine diabetes management had better knowledge of risks, prevention and treatment. Social determinants including cultural inequity/post colonialism, economic background and education were found to heavily impact an Indigenous Australian's capability to access appropriate care and adequately manage diabetes.
The findings of this study may be used to develop Indigenous community driven health promotion materials targeting the gap in knowledge around risk, prevention and treatment of diabetic eye diseases. Embedding screening for diabetic eye diseases into routine primary care and chronic disease management may help increase knowledge of prevention among Indigenous patients as well as early detection.
This poster presents the protocol for a systematic meta-narrative review, which will identify empirical studies that have encouraged the participation of Aboriginal communities and included the perspectives and experiences of Aboriginal people (including patients, carers, family, community members) in research related directly to Aboriginal health. The review will provide a foundation to one authors’ (AY) PhD, a participatory action research study which is investigating the way Aboriginal patients experience eye care services in the N.T and NSW, Australia, and how this relates to clinical journeys and outcomes, social determinants and health equity. The study as a whole aims to apply findings and recommendations gathered through qualitative interviews with community members and health staff directly into Continuous Quality Improvement (CQI) measures and training through the overarching Vision CRC project.
The importance of the review and where it sits within the wider study, processes and methodology will be presented. All sampled literature gathered in this review will be collated and analysed using meta-narrative methodology, creating a fuller picture of current evidence. This approach was chosen so that differences and commonalities in conceptualisation, theoretical approaches and empirical findings may be examined across the wide spectrum of research traditions involved in Aboriginal health. The findings of this review will provide important and useful evidence for those working in the Aboriginal health sector, and contribute towards a deeper understanding of ‘best practice’ in Aboriginal health research.