Publications by authors named "Roz Walker"

Introduction: Reflexivity is crucial for researchers and health professionals working within Aboriginal health. Reflexivity provides a tool for non-Aboriginal researchers to contribute to the broader intention of reframing historical academic positivist paradigms into Indigenous research methodologies (IRM) to privilege Aboriginal voices in knowledge construction and decision-making. This practice requires researchers to transition from safe and familiar research environments into unfamiliar and uncomfortable spaces.

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Background: Healthy skin is important for maintaining overall physical and cultural health and wellbeing. However, remote-living Australian Aboriginal children contend with disproportionally high rates of (Strep A) infected impetigo. The SToP Trial was a large stepped-wedge cluster randomised trial of See, Treat, and Prevent (SToP) skin health activities implemented between 2019 and 2022 in the Kimberley region of Western Australia, during which a decrease in impetigo was observed.

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Article Synopsis
  • A study was conducted to evaluate the impact of a holistic skin control program, SToP, aimed at reducing impetigo among children in remote communities of the Kimberley, Western Australia.
  • The trial involved skin checks, treatment training, and health promotion, targeting children aged 0-18 years in a stepped-wedge randomization process.
  • Results showed a significant decline in impetigo cases, particularly noted during initial baseline skin checks prior to the official intervention, with 85% of consented children receiving at least one skin assessment.
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Perinatal mental health is vital for mothers, infants, and families. Aboriginal mothers, despite their strengths, face greater mental health disparities due to colonisation and trauma. Traditional screening methods lack cultural sensitivity.

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Aim: To identify the barriers and facilitators for timely detection and optimal management of otitis media (OM) in Aboriginal children in a primary care setting from the perspective of carers of Aboriginal children.

Methods: A qualitative, Aboriginal co-designed, participatory action research study with interviews and focus groups in a large town in the Kimberley, Western Australia. The Consolidated Framework for Implementation Research informed stakeholder group identification and interview framework development.

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Introduction: For millennia, Aboriginal people's ways of knowing, doing and being were shared through art, song, and dance. Colonisation silenced these ways, affecting loss of self-determination for Aboriginal people. Over the past decade in Australia, hip-hop projects have become culturally appropriate approaches for health promotion.

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Aboriginal perinatal mothers are at a significant risk of experiencing mental health problems, which can have profound negative impacts, despite their overall resilience. This work aimed to build prediction models for identifying high psychological distress among Aboriginal perinatal mothers by coupling machine learning models with an innovative and culturally-safe screening tool. The original dataset of 179 Aboriginal mothers with 337 variables was obtained from twelve perinatal health settings at Perth metropolitan and regional centers in Western Australia between July and September 2022, using a specifically designed web-based rubric for the perinatal mental health assessment.

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Background: While there are many skin infections, reducing the burden of scabies and impetigo for remote living Aboriginal people, particularly children remains challenging. Aboriginal children living in remote communities have experienced the highest reported rate of impetigo in the world and are 15 times more likely to be admitted to hospital with a skin infection compared to non-Aboriginal children. Untreated impetigo can develop into serious disease and may contribute to the development of acute rheumatic fever (ARF) and rheumatic heart disease (RHD).

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Background: Aboriginal children hospitalised with acute lower respiratory infections (ALRIs) are at-risk of developing bronchiectasis, which can progress from untreated protracted bacterial bronchitis, often evidenced by a chronic (>4 weeks) wet cough following discharge. We aimed to facilitate follow-up for Aboriginal children hospitalised with ALRIs to provide optimal management and improve their respiratory health outcomes.

Methods: We implemented an intervention to facilitate medical follow-up four weeks after hospital discharge from a paediatric hospital in Western Australia.

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Background: Nutrition in pregnancy is pivotal to optimizing infant growth and maternal well-being. The factors affecting Indigenous people's food and nutrition intake are complex with a history of colonization impacting the disproportionate effect of social determinants to this day. Literature regarding the dietary intake or dietary priorities of Indigenous women in Australia is scarce, with supportive, culturally appropriate resources developed for and with this group rare.

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Objective: To explore the experiences of young people and their parents regarding the impact on school performance due to time away from school for orthodontic appointments and to explore their views about a possible extension to the current service.

Design: A qualitative study using semi-structured interviews.

Setting: UK district hospitals.

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Introduction: Group A (GAS) causes pharyngitis (sore throat) and impetigo (skin sores) GAS pharyngitis triggers rheumatic fever (RF) with epidemiological evidence supporting that GAS impetigo may also trigger RF in Australian Aboriginal children. Understanding the concurrent burden of these superficial GAS infections is critical to RF prevention. This pilot study aimed to trial tools for concurrent surveillance of sore throats and skins sore for contemporary studies of RF pathogenesis including development of a sore throat checklist for Aboriginal families and pharynx photography.

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Objective: Maternal mental disorders have been associated with adverse perinatal outcomes such as low birthweight and preterm birth, although these links have been examined rarely among Australian Aboriginal populations. We aimed to evaluate the association between maternal mental disorders and adverse perinatal outcomes among Aboriginal births.

Methods: We used whole population-based linked data to conduct a retrospective cohort study ( = 38,592) using all Western Australia singleton Aboriginal births (1990-2015).

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Background: In children, chronic wet cough may be a sign of underlying lung disease, including protracted bacterial bronchitis (PBB) and bronchiectasis. Chronic (> 4 weeks in duration) wet cough (without indicators pointing to alternative causes) that responds to antibiotic treatment is diagnostic of PBB. Timely recognition and management of PBB can prevent disease progression to irreversible bronchiectasis with lifelong consequences.

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Objective: Recruitment in research can be challenging in Australian Aboriginal contexts. We aimed to evaluate the SToP (See, Treat, Prevent skin infections) trial recruitment approach for Aboriginal families to identify barriers and facilitators and understand the utility of the visual resource used.

Methods: This qualitative participatory action research used purposive sampling to conduct six semi-structured interviews with staff and five yarning sessions with Aboriginal community members from the nine communities involved in the SToP trial that were audio recorded and transcribed verbatim before thematic analysis.

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Article Synopsis
  • The study investigates the prevalence of respiratory diseases such as protracted bacterial bronchitis (PBB), chronic suppurative lung disease (CSLD), bronchiectasis, and asthma in Aboriginal children under 18 in four remote communities of Western Australia.
  • A total of 392 children participated, revealing that 17.9% had chronic respiratory issues, with notable rates of PBB (7.7%), CSLD (3.3%), bronchiectasis (1.3%), and asthma (4.3%).
  • The findings indicate a significant disease burden in Aboriginal children, emphasizing the need for immediate strategies to combat these chronic respiratory conditions, especially as chronic wet cough prevalence rises with age.
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Rheumatic heart disease (RHD) significantly impacts the lives of First Nations Australians. Failure to eliminate RHD is in part attributed to healthcare strategies that fail to understand the lived experience of RHD. To rectify this, a PhD study was undertaken in the Northern Territory (NT) of Australia, combining Aboriginal ways of knowing, being and doing with interviews (24 participants from clinical and community settings) and participant observation to privilege Aboriginal voices, including the interpretations and experiences of Aboriginal co-researchers (described in the adjunct article).

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Research remains a site of struggle for First Nations peoples globally. Biomedical research often reinforces existing power structures, perpetuating ongoing colonisation by dominating research priorities, resource allocation, policies, and services. Addressing systemic health inequities requires decolonising methodologies to facilitate new understandings and approaches.

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Background: First Nations children hospitalised with acute lower respiratory infections (ALRIs) are at increased risk of future bronchiectasis (up to 15-19%) within 24-months post-hospitalisation. An identified predictive factor is persistent wet cough a month after hospitalisation and this is likely related to protracted bacterial bronchitis which can progress to bronchiectasis, if untreated. Thus, screening for, and optimally managing, persistent wet cough one-month post-hospitalisation potentially prevents bronchiectasis in First Nations' children.

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The purpose of this paper is to highlight a perspective for decolonizing research with Australian First Nations and provide a framework for successful and sustained knowledge translation by drawing on the recent work conducted by a research group, in five remote communities in North-Western Australia. The perspective is discussed in light of national and international calls for meaningful and dedicated engagement with First Nations people in research, policy and practice, to help close the health gap between First Nations and other Australians.

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Article Synopsis
  • High rates of acute respiratory tract infections among Aboriginal children lead to a significant burden of bronchiectasis post-hospitalization, yet medical follow-up after discharge is often lacking.
  • The study involved parents and pediatric hospital staff to identify barriers (like lack of information and awareness) and facilitators (such as culturally tailored training for clinicians) that affect the follow-up process.
  • A twelve-step plan was developed to enhance medical follow-up for these children, emphasizing the need for a comprehensive approach that involves collaboration among parents, hospital staff, and healthcare services.
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In common with colonized Indigenous people worldwide, many Australian Aboriginal people experience inequitable health outcomes. While the commitment and advocacy of researchers and health practitioners has resulted in many notable improvements in policy and practice, systemic and structural impediments continue to restrain widespread gains in addressing Indigenous health injustices. We take Rheumatic Heart Disease (RHD), a potent marker of extreme health inequity, as a case study, and critically examine RHD practitioners' perspectives regarding the factors that need to be addressed to improve RHD prevention and care.

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