Indigenous health: Overview

First Nations* Health and Wellbeing - The Lowitja Journal is the official journal of the Lowitja Institute, Australia's first community-controlled research institute. It is a community-controlled, international, community member, inter- and multi-disciplinary peer-reviewed open access journal that is dedicated to expanding access to First Nations research. We focus on primary research papers, systematic reviews, and informed short reports and community contributions on all aspects of the science, culture, philosophy and practice regarding health and wellbeing for First Nations communities.

Abstract
Purpose
Chronic pain/mamae is a major public health problem worldwide, and disproportionately affects Indigenous populations impacted by colonisation. In Aotearoa New Zealand, Indigenous Māori experience a greater burden of chronic pain than non-Māori. However, pain services based on Western models are unlikely to adequately meet the needs of Indigenous peoples. Little is published about traditional Māori views of, or approaches to, managing mamae/pain, knowledge that is traditionally held by Kaumātua/Elders. Therefore, this study aimed to understand Kaumātua (Māori Elder) views on the effects of pain, traditional pain management practices and mātauranga Māori (Māori knowledge) relating to managing pain.
Methods
Fourteen Kaumātua participated in individual interviews or a hui/focus group. Methods honoured tikanga (Māori protocol) and centralised whanaungatanga (relationships). Interviews and the hui/focus group were transcribed, and reflexive thematic analysis was conducted.
Main findings
Three themes were developed: 1. The multidimensional aspects of pain. Pain stretched beyond the physical and encompassed emotional and mental trauma, wairua/spiritual pain, grief from the loss of loved ones, contamination of the environment or breaches of tikanga/protocol. Some mamae/pain was described as everlasting, passing between people or generations. 2.Whakawhanaungatanga/relationships: Healing through connection. Healing of pain was seen to occur through strengthening connections with people, the spiritual realm, the natural world and with papakāinga (one’s ancestral homeland). 3.Tino Rangatiratanga/self-determination: Strength to self-manage pain. Self-reliance to manage pain and self-determination to make health decisions were critical, and a stoical approach to pain was described. Stoicism was noted to avoid perceptions of weakness and burdening whānau/family, but may inhibit emotional expression, connection and healing.
Principal conclusions
Mātauranga Māori/Māori knowledge emphasises that pain and its healing should be considered multidimensional, incorporating physical, mental and relational components, existing in the spiritual realm and incorporating links between people, places, the past and future. Individuals may approach pain with a stoical approach, which has both positive and negative features. Pain services may wish to incorporate this knowledge of the spiritual, social and psychological aspects of pain and pain management to provide more meaningful care for people with pain.

Abstract
Background: Together with addressing social determinants of health, culturally safe healthcare provision is essential for closing the health outcomes gap experienced by Aboriginal and Torres Strait Islander (Indigenous) Australians. Rural placements potentially provide students of the health professions with opportunities to enhance their knowledge and skills regarding cultural safety. We used rural placements data systematically collected from allied health students, including commencement- and end-of-placement questionnaire responses, to investigate the determinants of confidence in working with Indigenous people.

Methods: The study comprised data from all students who provided survey data at both commencement and end of their first placement directly supervised by the administering University Department of Rural Health during the period 2019-2022. Five-point ordered responses to the question 'How confident do you feel about working with Aboriginal people?' were used to assess student and placement-related determinants of confidence (Confident/Very confident versus other) at baseline and increased confidence (≥ 1 point) during the placement using crude and adjusted multivariable robust Poisson regression.

Results: Participating students (N = 489) were from diverse allied health disciplines (including pharmacy n = 94, 19.2%; chiropractic n= 66, 13.5%; physiotherapy n= 65, 13.3%; social work n = 59, 12.1%; and occupational therapy 58, 11.9%). Confidence in dealing with Aboriginal people was lower at commencement among females compared with males (adjusted relative risk [aRR] 0.65; 95% confidence interval [CI] 0.53-0.80), and higher among students of Australian rural origin compared with others (aRR 1.49; CI 1.22-1.83) and those who reported previous experience working with Indigenous people compared with those reporting none (aRR 1.40; CI 1.14-1.72). Placement attributes associated with increased confidence working with Indigenous people between placement commencement and end were interaction with Indigenous people within the placement (aRR 2.32; CI 1.24-4.34), placement model reflecting more structured academic supervision (aRR 1.18; CI 1.02-1.37), and placement length (aRR per additional day 1.002; CI 1.001-1.004). These associations were robust to modelling that accounted for a ceiling effect on increased confidence.

Conclusions: While influenced by students' demographic attributes and prior experiences, confidence of allied health students in working with Indigenous people is enhanced during rural placements, particularly through direct contact with Indigenous people.