Written by Alexandra Kilian

The disproportionate burden of mental health disorders among Australian Aboriginal young people has been well established (1, 2). This is, undoubtedly, related to the fact that Aboriginal populations have been resisting colonization for hundreds of years, and the process of colonization, as well as current systemic racism and social marginalization have left deep scars in Aboriginal communities (3).

The recognition of the historical impact of trauma on Aboriginal populations defines the Sax Institute’s approach to research in and with Aboriginal communities. The Institute’s flagship project in Aboriginal health is referred to as SEARCH, which stands for the “Study of Environment on Resilience and Child Health”. As described in the published methods, “SEARCH is built on strong community partnerships, under Aboriginal leadership, and addresses community priorities” (4). The SEARCH study is a powerful tool by which research-based advocacy occurs. The project is Aboriginal owned and the research team from the Sax Institute supports the Aboriginal community in helping to answer questions that are identified as necessary by the community (4, 5). The Sax Institute, in partnership with Aboriginal communities, advocates for change based on the results of the study. For example, the first phase of the project identified high rates of middle ear infections among Aboriginal youth. In response, the Sax Institute was able to facilitate the provision of specialist services at participating Aboriginal Controlled Community Health Services (ACCHSs), thus increasing the accessibility of treatment for Aboriginal children (5).

The SEARCH team attributes its success and real world impact to several factors, including Aboriginal leadership, strong governance based on foundational guiding principles, and the explicit focus on using data to improve health (5). Data gathered is returned to the communities, who govern its analysis, presentation and dissemination (5). The study builds Aboriginal research capacity through training and the employment of Aboriginal research officers and knowledge and the communities are supported in using the data to drive change that is important to them (5). Working within such an innovative and collaborative research environment has taught me several lessons.

First, genuine partnerships are important at all levels. Since their inceptions, the relationships between the Sax Institute and Aboriginal communities have been continually strengthened and reinforced through various measures. The study employs Aboriginal knowledge brokers who work as a liaison between the Sax Institute and Aboriginal communities. Their role is to help study investigators understand Aboriginal needs, while helping Aboriginal communities understand and use the data and results presented by the study investigators (5). As well, regular decision making forums that include Aboriginal community members and representatives from the ACCHSs ensure a collaborative decision making process that benefits the community (5). These are just some of the ways that the Aboriginal communities and the Institute are in constant communication, engaging in a constructive discourse that drives the continual evolution of the study. In this discourse, community experience is valued and feedback is appreciated. This ensures that the study is continually meeting the evolving needs of the communities in which it is present. As well, the Institute uses its partnerships with government organizations and other stakeholders to secure funding and drive change on a systemic level, based on study results. Finally, on a more local level, the research process is also dependent on relationships and community networks. The research officers responsible for the data collection are of Aboriginal heritage, and often grew up in the communities in which they now work. Their community knowledge, resulting from lifelong relationships in their communities facilitates data collection. For example, the community knowledge of Aboriginal research officers has facilitated communication with study participants, particularly in order to invite them for follow-up, thus increasing study retention (5). The work of Aboriginal research officers is a testament to the strength and extent of Aboriginal community networks and is a demonstration of an incredible commitment to community wellbeing.

Secondly, the continuing negative framing of problems may have negative consequences on outcomes. While I was at a research team meeting during my time at the Sax Institute, several knowledge brokers spoke about the need to alter how problems are framed. A negative framing of the problem, in which poor health outcomes are constantly emphasized, does not acknowledge the incredible health-related changes that the populations have made, with direct improvements in health outcomes. For example, while many sources may communicate that Aboriginal Australians experience higher rates of smoking and obesity and are more likely to have high blood pressure, diabetes and renal disease (6), few emphasize that between 1981 and 2011, the death rate due to cardiovascular disease fell by 71 percent among Aboriginal males (7). Those statistics more accurately reflect the efforts by individuals and communities to overcome significant, often systemic, challenges and effect change. Moreover, these statistics reflect that more positive progress is possible. Additionally, if results are constantly framed negatively, research funding may become difficult to obtain, as funders may not see the impact that their investments are having in communities. Similarly, policy makers may see policy initiatives as futile. As such, to promote further progress when working to solve a problem, we need to acknowledge positive change and build on the success of past solutions.

The context of the data are as important as the results. When SEARCH was conceptualized, the Steering Committee made it a priority to identify community needs (5). It was found that one of the community priorities was a holistic approach to health research (5). This reflects the Aboriginal view of health and wellbeing, and also recognizes that context plays an important role in how and why problems present, as well as how effective a solution might be, if implemented. In SEARCH, the knowledge and expertise of Aboriginal knowledge brokers assures that study methods are appropriate to the context of the communities and that that data analysis reflects these contextual considerations.

Watching contextual analysis and response take place within the SEARCH project taught me that, as researchers, when we see data we have a responsibility to ask “Why?”. Context drives and defines data analysis and the development of conclusions and subsequent solutions. If data is presented extra-contextually we do not sufficiently understand nor acknowledge the upstream factors that contribute to other numbers that we see and this leaves little room for the generation of solutions.

A responsive health system recognizes the need for constant change and adaptability, and embraces the diversity of the population it was built to serve. My internship at the Sax Institute left me with the lasting impression that working with populations that are underrepresented and underserviced by our current health system, can help increase health system responsiveness. By working with the SEARCH team on a community-based project in Aboriginal health, I learned to reflect on the broader impact of how a problem is framed and left with a deeper appreciation for the value of relationships at different levels within the research environment as well as of the importance of context in data analysis. These lessons will define all of my future research, as I strive to better understand and address the unique needs of vulnerable populations in Canada.

References

  1. SR Z, DM L, SR S, E B, H M, Wilkes T E, et al. The Western Australian Aboriginal Child Health Survey: The Health of Aboriginal Children and Young People. Perth: Telethon Institute for Child Health Research, 2004.
  2. Blair EM, Zubrick SR, Cox AH. The Western Australian Aboriginal Child Health Survey: findings to date on adolescents. Med J Aust. 2005;183(8):3.
  3. Swan P, Raphael B. Ways Forward: National Consultancy Report on Aboriginal and Torres Strait Islander Mental Health. Australian Government Publishing Service: Canberra; 1995.
  4. SEARCH Investigators. The Study of environment on Aboriginal resilience and child health (SEARCH): study protocol. BMC Public Health. 2010 May 28;10(1):287.
  5. Wrighta D, Gordonb R, Carrc D, Craigd JC, Banksf E, Muthayyag S, Wutzkeh S, Eadesj SJ. The Study of Environment on Aboriginal Resilience and Child Health (SEARCH): a long-term platform for closing the gap. Public health research & practice. 2016 Jul 15;26(3).
  6. Australian Institute of Health and Welfare (AIHW). Heart, stroke and vascular diseases: Australian facts 2004. AIHW Cat. No. CVD 27. Canberra: Australian Institute of Health and Welfare National Heart Foundation of Australia,
  7. Close the Gap Campaign Steering Committee. Progress and priorities report 2015. Close the Gap Campaign Steering Committee for Indigenous Health Equality; 2015.

Watch the video from Alex’s QE Scholar Insights webinar:

Watch the video, produced by the Sax Institute, as Alex shares her insights into the value of partnership research in Aboriginal health: