The Heart Health Project was developed in partnership between Aboriginal health and social organi... more The Heart Health Project was developed in partnership between Aboriginal health and social organisations in the Goulburn-Murray region and university departments. The aims included screening for cardiovascular disease (CVD) risk factors, and evaluating community-directed interventions. We describe the development of the Heart Health Project and the results of risk factor screening among employees (n=66) of Aboriginal organisations during 2003-04. Screening identified few new cases of overt hypertension, diabetes or hypercholesterolaemia, but did find a large proportion of the survey sample who smoked, had evidence of periodontal disease or who had ?high normal? levels of risk factors at a relatively young age, placing them at risk of developing overt disease. Barriers to diet and exercise behaviours thought to protect against CVD were documented. While appropriate planning made clinical follow-up relatively straightforward, effective referral of at-risk people to primary prevention ...
Background: Aboriginal Community Controlled Organisations (ACCOs) provide community-focussed and ... more Background: Aboriginal Community Controlled Organisations (ACCOs) provide community-focussed and culturally safe services for First Peoples in Australia, including crisis intervention and health promotion activities, in a holistic manner. The ecological model of health promotion goes some way towards describing the complexity of such health programs. The aims of this project were to: 1) identify the aims and purpose of existing health promotion programs conducted by an alliance of ACCOs in northern Victoria, Australia; and 2) evaluate the extent to which these programs are consistent with an ecological model of health promotion, addressing both individual and environmental determinants of health. Methods: The project arose from a long history of collaborative research. Three ACCOs and a university formed the Health Promotion Alliance to evaluate their health promotion programs. Local community members were trained in, and contributed to developing culturally sensitive methods for, data collection. Information on the aims and design of 88 health promotion activities making up 12 different programs across the ACCOs was systematically and prospectively collected. Results: There was a wide range of activities addressing environmental and social determinants of health, as well as physical activity, nutrition and weight loss. The design of the great majority of activities had a minimal Western influence and were designed within a local Aboriginal cultural framework. The most common focus of the activities was social connectedness (76 %). Physical activity was represented in two thirds of the activities, and nutrition, weight loss and culture were each a focus of about half of the activities. A modified coding procedure designed to assess the ecological nature of these programs showed that they recruited from multiple settings; targeted a range of individual, social and environmental determinants; and used numerous and innovative strategies to achieve change. Conclusion: First Peoples' health promotion in the Goulburn-Murray Rivers region encompasses a broad range of social, cultural, lifestyle and community development activities, including reclaiming and strengthening cultural identity and social connectedness as a response to colonisation.
Background: In Australia, significant resources have been invested in producing health promotion ... more Background: In Australia, significant resources have been invested in producing health promotion best practice guidelines, frameworks and tools (herein referred to as health promotion tools) as a strategy to improve Indigenous health promotion programmes. Yet, there has been very little rigorous implementation research about whether or how health promotion tools are implemented. This paper theorizes the complex processes of health promotion tool implementation in Indigenous comprehensive primary healthcare services. Methods: Data were derived from published and grey literature about the development and the implementation of four Indigenous health promotion tools. Tools were theoretically sampled to account for the key implementation types described in the literature. Data were analysed using the grounded-theory methods of coding and constant comparison with construct a theoretical implementation model. Results: An Indigenous Health Promotion Tool Implementation Model was developed. Implementation is a social process, whereby researchers, practitioners and community members collectively interacted in creating culturally responsive health promotion to the common purpose of facilitating empowerment. The implementation of health promotion tools was influenced by the presence of change agents; a commitment to reciprocity and organizational governance and resourcing. Conclusion: The Indigenous Health Promotion Tool Implementation Model assists in explaining how health promotion tools are implemented and the conditions that influence these actions. Rather than simply developing more health promotion tools, our study suggests that continuous investment in developing conditions that support empowering implementation processes are required to maximize the beneficial impacts and effectiveness of health promotion tools.
The Rumbalara Football and Netball Club (RFNC) was accepted into the Goulburn Valley Football Lea... more The Rumbalara Football and Netball Club (RFNC) was accepted into the Goulburn Valley Football League for the 1997 football and netball season. Since this acceptance into a mainstream 1 league, the Club has won a total of 20 premierships between the 4 football and 8 netball divisions. In 1999, the Goulburn Valley Football League second division split from the league, forming the Central Goulburn Football League (CGFL). Rumbalara's first-division football team won the CGFL's first premiership, won again in 2002, and was the runner-up in 2003 and 2004. The netball teams have been even more impressive, with the A-grade winning premiership in three consecutive years from 2001 to 2003 and then again in 2008. Since the first grand final victory in 1998 (exactly 100 years after the first premiership won by the Cummeragunja team to which RFNC traces its ancestry), the Club has defied all the odds. Sport was the original activity that brought Aboriginal people to RFNC in 1997. This wa...
International Journal of Environmental Research and Public Health, 2013
Objective: Effective interventions to improve population and individual health require environmen... more Objective: Effective interventions to improve population and individual health require environmental change as well as strategies that target individual behaviours and clinical factors. This is the basis of implementing an ecological approach to health programs and health promotion. For Aboriginal People and Torres Strait Islanders, colonisation has made the physical and social environment particularly detrimental for health. Methods and Results: We conducted a literature review to identify Aboriginal health interventions that targeted environmental determinants of health, identifying 21 different health programs. Program activities that targeted environmental determinants of health included: Caring for Country; changes to food supply and/or policy; infrastructure for physical activity; housing construction and maintenance; anti-smoking policies;
The Heart Health Project is an ongoing community-directed health promotion programme encompassing... more The Heart Health Project is an ongoing community-directed health promotion programme encompassing the collection of health-related data and interventions promoting cardiovascular health. Following research which has emphasised the importance of psychological factors including mastery, or personal control, in mitigating cardiovascular health outcomes, this qualitative study explored whether such constructs were relevant from Indigenous perspectives, or whether there were other, more meaningful and relevant psychosocial factors identified by participants that should be incorporated into models of Indigenous health and which could be effective targets for change. The study fits within the broader participatory action research design of the Heart Health Project. Data comprised 30 in-depth interviews with members of a rural Aboriginal community in south-eastern Australia to identify psychosocial factors relevant to their health. Interviews were semi-structured and carried out by two interviewers, one Aboriginal and one non-Aboriginal. Qualitative analysis using QN6 software resulted in a number of salient themes and sub-themes. These are summarised using extracts from the data. Five major themes and 15 sub-themes emerged from data analysis. The findings indicated that while a sense of control may be one factor impacting on health and health behaviours, there were other factors that participants spoke about more readily that have specific relevance to the social and cultural context of Indigenous health. These included history, relationship with mainstream and connectedness. These may be worthy of further empirical investigation and are likely to assist in the design of community health promotion interventions for Aboriginal people.
Background: For health promotion to be effective in Aboriginal and Torres Strait Islander Communi... more Background: For health promotion to be effective in Aboriginal and Torres Strait Islander Communities, interventions (and their evaluation) need to work within a complex social environment and respect Indigenous knowledge, culture and social systems. At present, there is a lack of culturally appropriate evaluation methods available to practitioners that are capable of capturing this complexity. As an initial response to this problem, we used two non-invasive methods to evaluate a community-directed health promotion program, which aimed to improve nutrition and physical activity for members of the Aboriginal community of the Goulburn-Murray region of northern Victoria, Australia. The study addressed two main questions. First, for members of an Aboriginal sporting club, what changes were made to the nutrition environment in which they meet and how is this related to national guidelines for minimising the risk of chronic disease? Second, to what degree was the overall health promotion program aligned with an ecological model of health promotion that addresses physical, social and policy environments as well as individual knowledge and behaviour? Methods: Rather than monitoring individual outcomes, evaluation methods reported on here assessed change in the nutrition environment (sports club food supply) as a facilitator of dietary change and the 'ecological' nature of the overall program (that is, its complexity with respect to numbers of targets, settings and strategies). Results: There were favourable changes towards the provision of a food supply consistent with Australian guidelines at the sports club. The ecological analysis indicated that the design and implementation of the program were consistent with an ecological model of health promotion. Conclusions: The evaluation was useful for assessing the impact of the program on the nutrition environment and for understanding the ecological nature of program activities.
This paper describes a health promotion program conducted within the Koori community of the Goulb... more This paper describes a health promotion program conducted within the Koori community of the Goulburn-Murray region of northern Victoria, Australia. The program was community-directed, state-funded and involved university researchers. The program comprised three separate but related activities devised and carried out within a Participatory Action Research framework with the aim of promoting nutrition and physical exercise. Although the activities did not always meet all their intended aims and problems arose with the evaluation of some activities, they were nonetheless deemed to have made a valuable and sometimes unexpected contribution to health promotion in the community. Principles of participation and collaboration were central to the program's success. Challenges and benefits of working in genuine partnership are discussed.
The Heart Health Project was developed in partnership between Aboriginal health and social organi... more The Heart Health Project was developed in partnership between Aboriginal health and social organisations in the Goulburn-Murray region and university departments. The aims included screening for cardiovascular disease (CVD) risk factors, and evaluating community-directed interventions. We describe the development of the Heart Health Project and the results of risk factor screening among employees (n=66) of Aboriginal organisations during 2003-04. Screening identified few new cases of overt hypertension, diabetes or hypercholesterolaemia, but did find a large proportion of the survey sample who smoked, had evidence of periodontal disease or who had "high normal" levels of risk factors at a relatively young age, placing them at risk of developing overt disease. Barriers to diet and exercise behaviours thought to protect against CVD were documented. While appropriate planning made clinical follow-up relatively straightforward, effective referral of at-risk people to primary p...
The Heart Health Project was developed in partnership between Aboriginal health and social organi... more The Heart Health Project was developed in partnership between Aboriginal health and social organisations in the Goulburn-Murray region and university departments. The aims included screening for cardiovascular disease (CVD) risk factors, and evaluating community-directed interventions. We describe the development of the Heart Health Project and the results of risk factor screening among employees (n=66) of Aboriginal organisations during 2003-04. Screening identified few new cases of overt hypertension, diabetes or hypercholesterolaemia, but did find a large proportion of the survey sample who smoked, had evidence of periodontal disease or who had ?high normal? levels of risk factors at a relatively young age, placing them at risk of developing overt disease. Barriers to diet and exercise behaviours thought to protect against CVD were documented. While appropriate planning made clinical follow-up relatively straightforward, effective referral of at-risk people to primary prevention ...
Background: Aboriginal Community Controlled Organisations (ACCOs) provide community-focussed and ... more Background: Aboriginal Community Controlled Organisations (ACCOs) provide community-focussed and culturally safe services for First Peoples in Australia, including crisis intervention and health promotion activities, in a holistic manner. The ecological model of health promotion goes some way towards describing the complexity of such health programs. The aims of this project were to: 1) identify the aims and purpose of existing health promotion programs conducted by an alliance of ACCOs in northern Victoria, Australia; and 2) evaluate the extent to which these programs are consistent with an ecological model of health promotion, addressing both individual and environmental determinants of health. Methods: The project arose from a long history of collaborative research. Three ACCOs and a university formed the Health Promotion Alliance to evaluate their health promotion programs. Local community members were trained in, and contributed to developing culturally sensitive methods for, data collection. Information on the aims and design of 88 health promotion activities making up 12 different programs across the ACCOs was systematically and prospectively collected. Results: There was a wide range of activities addressing environmental and social determinants of health, as well as physical activity, nutrition and weight loss. The design of the great majority of activities had a minimal Western influence and were designed within a local Aboriginal cultural framework. The most common focus of the activities was social connectedness (76 %). Physical activity was represented in two thirds of the activities, and nutrition, weight loss and culture were each a focus of about half of the activities. A modified coding procedure designed to assess the ecological nature of these programs showed that they recruited from multiple settings; targeted a range of individual, social and environmental determinants; and used numerous and innovative strategies to achieve change. Conclusion: First Peoples' health promotion in the Goulburn-Murray Rivers region encompasses a broad range of social, cultural, lifestyle and community development activities, including reclaiming and strengthening cultural identity and social connectedness as a response to colonisation.
Background: In Australia, significant resources have been invested in producing health promotion ... more Background: In Australia, significant resources have been invested in producing health promotion best practice guidelines, frameworks and tools (herein referred to as health promotion tools) as a strategy to improve Indigenous health promotion programmes. Yet, there has been very little rigorous implementation research about whether or how health promotion tools are implemented. This paper theorizes the complex processes of health promotion tool implementation in Indigenous comprehensive primary healthcare services. Methods: Data were derived from published and grey literature about the development and the implementation of four Indigenous health promotion tools. Tools were theoretically sampled to account for the key implementation types described in the literature. Data were analysed using the grounded-theory methods of coding and constant comparison with construct a theoretical implementation model. Results: An Indigenous Health Promotion Tool Implementation Model was developed. Implementation is a social process, whereby researchers, practitioners and community members collectively interacted in creating culturally responsive health promotion to the common purpose of facilitating empowerment. The implementation of health promotion tools was influenced by the presence of change agents; a commitment to reciprocity and organizational governance and resourcing. Conclusion: The Indigenous Health Promotion Tool Implementation Model assists in explaining how health promotion tools are implemented and the conditions that influence these actions. Rather than simply developing more health promotion tools, our study suggests that continuous investment in developing conditions that support empowering implementation processes are required to maximize the beneficial impacts and effectiveness of health promotion tools.
The Rumbalara Football and Netball Club (RFNC) was accepted into the Goulburn Valley Football Lea... more The Rumbalara Football and Netball Club (RFNC) was accepted into the Goulburn Valley Football League for the 1997 football and netball season. Since this acceptance into a mainstream 1 league, the Club has won a total of 20 premierships between the 4 football and 8 netball divisions. In 1999, the Goulburn Valley Football League second division split from the league, forming the Central Goulburn Football League (CGFL). Rumbalara's first-division football team won the CGFL's first premiership, won again in 2002, and was the runner-up in 2003 and 2004. The netball teams have been even more impressive, with the A-grade winning premiership in three consecutive years from 2001 to 2003 and then again in 2008. Since the first grand final victory in 1998 (exactly 100 years after the first premiership won by the Cummeragunja team to which RFNC traces its ancestry), the Club has defied all the odds. Sport was the original activity that brought Aboriginal people to RFNC in 1997. This wa...
International Journal of Environmental Research and Public Health, 2013
Objective: Effective interventions to improve population and individual health require environmen... more Objective: Effective interventions to improve population and individual health require environmental change as well as strategies that target individual behaviours and clinical factors. This is the basis of implementing an ecological approach to health programs and health promotion. For Aboriginal People and Torres Strait Islanders, colonisation has made the physical and social environment particularly detrimental for health. Methods and Results: We conducted a literature review to identify Aboriginal health interventions that targeted environmental determinants of health, identifying 21 different health programs. Program activities that targeted environmental determinants of health included: Caring for Country; changes to food supply and/or policy; infrastructure for physical activity; housing construction and maintenance; anti-smoking policies;
The Heart Health Project is an ongoing community-directed health promotion programme encompassing... more The Heart Health Project is an ongoing community-directed health promotion programme encompassing the collection of health-related data and interventions promoting cardiovascular health. Following research which has emphasised the importance of psychological factors including mastery, or personal control, in mitigating cardiovascular health outcomes, this qualitative study explored whether such constructs were relevant from Indigenous perspectives, or whether there were other, more meaningful and relevant psychosocial factors identified by participants that should be incorporated into models of Indigenous health and which could be effective targets for change. The study fits within the broader participatory action research design of the Heart Health Project. Data comprised 30 in-depth interviews with members of a rural Aboriginal community in south-eastern Australia to identify psychosocial factors relevant to their health. Interviews were semi-structured and carried out by two interviewers, one Aboriginal and one non-Aboriginal. Qualitative analysis using QN6 software resulted in a number of salient themes and sub-themes. These are summarised using extracts from the data. Five major themes and 15 sub-themes emerged from data analysis. The findings indicated that while a sense of control may be one factor impacting on health and health behaviours, there were other factors that participants spoke about more readily that have specific relevance to the social and cultural context of Indigenous health. These included history, relationship with mainstream and connectedness. These may be worthy of further empirical investigation and are likely to assist in the design of community health promotion interventions for Aboriginal people.
Background: For health promotion to be effective in Aboriginal and Torres Strait Islander Communi... more Background: For health promotion to be effective in Aboriginal and Torres Strait Islander Communities, interventions (and their evaluation) need to work within a complex social environment and respect Indigenous knowledge, culture and social systems. At present, there is a lack of culturally appropriate evaluation methods available to practitioners that are capable of capturing this complexity. As an initial response to this problem, we used two non-invasive methods to evaluate a community-directed health promotion program, which aimed to improve nutrition and physical activity for members of the Aboriginal community of the Goulburn-Murray region of northern Victoria, Australia. The study addressed two main questions. First, for members of an Aboriginal sporting club, what changes were made to the nutrition environment in which they meet and how is this related to national guidelines for minimising the risk of chronic disease? Second, to what degree was the overall health promotion program aligned with an ecological model of health promotion that addresses physical, social and policy environments as well as individual knowledge and behaviour? Methods: Rather than monitoring individual outcomes, evaluation methods reported on here assessed change in the nutrition environment (sports club food supply) as a facilitator of dietary change and the 'ecological' nature of the overall program (that is, its complexity with respect to numbers of targets, settings and strategies). Results: There were favourable changes towards the provision of a food supply consistent with Australian guidelines at the sports club. The ecological analysis indicated that the design and implementation of the program were consistent with an ecological model of health promotion. Conclusions: The evaluation was useful for assessing the impact of the program on the nutrition environment and for understanding the ecological nature of program activities.
This paper describes a health promotion program conducted within the Koori community of the Goulb... more This paper describes a health promotion program conducted within the Koori community of the Goulburn-Murray region of northern Victoria, Australia. The program was community-directed, state-funded and involved university researchers. The program comprised three separate but related activities devised and carried out within a Participatory Action Research framework with the aim of promoting nutrition and physical exercise. Although the activities did not always meet all their intended aims and problems arose with the evaluation of some activities, they were nonetheless deemed to have made a valuable and sometimes unexpected contribution to health promotion in the community. Principles of participation and collaboration were central to the program's success. Challenges and benefits of working in genuine partnership are discussed.
The Heart Health Project was developed in partnership between Aboriginal health and social organi... more The Heart Health Project was developed in partnership between Aboriginal health and social organisations in the Goulburn-Murray region and university departments. The aims included screening for cardiovascular disease (CVD) risk factors, and evaluating community-directed interventions. We describe the development of the Heart Health Project and the results of risk factor screening among employees (n=66) of Aboriginal organisations during 2003-04. Screening identified few new cases of overt hypertension, diabetes or hypercholesterolaemia, but did find a large proportion of the survey sample who smoked, had evidence of periodontal disease or who had "high normal" levels of risk factors at a relatively young age, placing them at risk of developing overt disease. Barriers to diet and exercise behaviours thought to protect against CVD were documented. While appropriate planning made clinical follow-up relatively straightforward, effective referral of at-risk people to primary p...
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Papers by Joyce Doyle