Juli Coffin

The Moombaki Research team developed a pilot Cultural Integrity Audit (CIA) that was co-designed with Aboriginal elders and educators as a tool for school leaders to measure the extent of culturally safe and responsive education at three test sites in Perth (Boorloo), Western Australia. This article analyses the political and social contexts and experiences of implementing the CIA as a tool – including the commitment, attitudes and values of school leaders. Observations are primarily informed by the viewpoint and the positionality of the Lead Investigator, an Aboriginal woman who has deep connections with local Aboriginal communities and significant experience working with schools in the study area. We discuss how non-Aboriginal teachers and school leaders fail to manage their own pedagogies of discomfort about Aboriginal people and their culture by adopting stances of neutrality and racially defensive practices. We suggest that non-Aboriginal school leaders and teachers practice educational leadership informed by Noongar reciprocity and acknowledge the Aboriginal identities of Aboriginal students, educators, families and communities. We suggest that school leaders consider processes of truth telling and truth listening that view the inclusion of Aboriginal ways of being, knowing and doing as enriching gifts and not an extra burden.

Objective
To determine the effect of cultural security training (CST) for health professionals and access to an Aboriginal Brain Injury Coordinator (ABIC) for Aboriginal Australians with stroke or traumatic brain injury (TBI).

Design
A stepped wedge cluster randomised controlled trial; the intervention package consisted of CST for hospital professionals and 6-month access to ABICs providing education, support, liaison and advocacy; the commencement order of the intervention phase was randomised.

Setting
Four urban and four rural hospitals in Western Australia, 2018–2022.

Participants
Aboriginal adults ≥ 18 years hospitalised with stroke or TBI.

Main Outcome Measures
Primary outcome was quality of life (Euro QOL–5D-3L Visual Analogue Scale (EQ-VAS)) score at 26 weeks post-injury. Secondary outcomes were modified Rankin Scale, Functional Independence Measure, Hospital Anxiety and Depression Scale, Modified Caregiver Strain Index at 12 and 26 weeks, rehabilitation occasions of service, hospital compliance with minimum processes of care (MPC), acceptability of interventions, feasibility of ABIC role and costs.

Results
In total, 108 participants recruited (target 312), 75% rural residents; 26-week outcomes assessment completed for 78% of participants. The adjusted mean QoL showed no significant difference (p = 0.83). The MPC outcome favored the intervention group, adjusted difference in means 6.8% at 26 weeks, 95% CI (0.40%, 13.26%). There were no significant differences between control and intervention groups for other secondary outcomes.

Conclusions
CST and implementation of an ABIC were feasible, acceptable and improved care processes for a predominantly rural population. Health outcomes did not differ. The effects of the COVID-19 context are discussed.

Trial Registration
ACTRN12618000139279

Since their arrival in the 1700s, horses have played a significant role in shaping the identity of rural and remote communities. However, Indigenous perspectives on the historical role of horses in communities have been largely underrepresented. In remote regions, where access to veterinary and medical services is limited, interactions between people and free-roaming horses present a potential risk for zoonotic disease transmission. This review identifies potential pathways for the transmission of equine zoonoses in rural and remote Aboriginal and Torres Strait Islander communities, aiming to inform participatory prevention programs. Despite an expansive review across 20 databases, only six studies discussed the risk factors and transmission pathways for equine zoonoses in Aboriginal and Torres Strait Islander communities. Across these six studies, five equine zoonoses were discussed, including diseases caused by Giardia, Cryptosporidium, Hendra virus, Methicillin-resistant Staphylococcus aureus and Streptococcus equi subsp. zooepidemicus. These studies cover only a small portion of the equine zoonoses that can potentially impact public health. The review also discusses the role of emerging equine zoonoses, including those caused by Chlamydia psittaci and vector-borne viruses, such as Ross River virus, West Nile virus and Japanese encephalitis virus. Together, these studies emphasise the need for greater focus on One Health in remote Australian communities. Recommendations for participatory approaches to disease prevention and key areas for future research on zoonotic disease transmission in these regions are also provided.

Language is significant for communicating knowledge across cultures and generations and has the power to attribute meanings and alter our worldviews. More than 250 Aboriginal and Torres Strait Islanders languages were spoken in 1788. This number has diminished to approximately 110 languages spoken in 2016, of which 90% were considered endangered in 2019. Language custodians and speakers across Australia are working to preserve and ensure languages are strongly spoken into the future. Language revitalisation initiatives can facilitate (re)connection to Country, cultures and communities and be recognised as acts of reconciliation for Aboriginal and Torres Strait Islander peoples. In a health context, recent evidence indicates that connection to language and culture is important in promoting overall health and wellbeing for Indigenous people. Embedding culture and language into health resources is now a key strategy for public health to reduce the existing health inequities experienced by Aboriginal and Torres Strait Islander people. With the increased demand for Indigenous language health promotion resources, practical policies and guidelines on development and distribution are required. Furthermore, investigation is warranted into the effectiveness and impact of local community context and how end users perceive and may apply these resources.

The Moombaki study team’s key objective is improving the well-being and educational success of Aboriginal children by fostering a deeper connection to their culture, land, and family. The current WA Department of Education Cultural Standards Framework (2015) is outdated and has not resulted in sustainable and audited meaningful changes to ways of working with Aboriginal children and their families. Our findings show that AIEOs provide valuable insights into the practices and values that may be more effective in meeting the needs of Aboriginal children. This article discusses the importance for national and state policy and frameworks to reflect Aboriginal ways of working in schools. Our findings from yarning circles with Aboriginal Indigenous Education Officers (AIEOs) interrogate the values informing and driving Noongar ways of working. Noongar cultural protocols exemplify Noongar ways of working. These protocols are guided by values that shape rules and practices rooted in a rich history passed down through generations of culture and customs. The analysis of the Moombaki yarning circles with AIEOs whose voices are central, revealed they upheld Aboriginal ways of working by emphasising four concentric circles of Aboriginal worldview: connections to kin, country, customs, and culture. Central to these ways of working is the value of trust, which meanders through and strengthens the practices of connection, sharing, and the central focus on children and family.

The Moombaki (where the river meets the sky) study hypothesises that increasing the knowledge and pride that Aboriginal children have of their identity will contribute positively toward their education, health and well-being outcomes. Through research yarning circles conducted at three urban primary schools in Boorloo (Perth), Aboriginal educators (Aboriginal and Islander Education Officers [AIEOs] and teachers) described how to respond to Aboriginal students’ needs in school environments. These included culturally safe environments for the provision of culturally responsive education. Forty-five non-Aboriginal teachers and school leaders (Principals and Vice-Principals) also participated. The article prioritises the voices of the Aboriginal educators and discusses the findings in relation to their lived experiences of working with non-Aboriginal educators. The findings show that AIEOs repeatedly manage the resistance and reluctance of non-Aboriginal educators to meaningfully collaborate in culturally safe and responsive ways. The findings also show the potential for non-Aboriginal staff to work alongside Aboriginal educators.

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. This uncomfortable space is often referred to as the ‘third space’—the ‘in-between’ space that can be turbulent and difficult to navigate. However, it is also a productive space where new collaborations are created, and ideas can emerge. This manuscript provides reflections from a cross-cultural team working on a transdisciplinary healthy skin program—the See, Treat, Prevent (SToP) Trial in Aboriginal communities in the Kimberley region of Western Australia (WA). Cultural mentors guided our team to work in an Oombarl Oombarl (steady steady) way to navigate the cultural interface between familiar biomedical elements and unknown health promotion activities. Our third space was the intangible space in-between the S, T and P of the SToP Trial.

Methods
Narratives were collected through semi-structured interviews and yarning sessions. All participants provided written consent for audio recording; in one instance, consent was provided to record graphically. A thematic analysis aligning with the question guide was conducted.

Findings
Reflections include team members' experiences of learning the Oombarl Oombarl way, individually and collectively. Initially, most team members revealed it was challenging to work in an Oombarl Oombarl way, having to move out of the safe, familiar research environment into the unknown community-led health promotion space. This in-between space became our third space—the uncomfortable space where we relinquished ‘control’ of research agendas and learnt to work to the rhythm of Aboriginal communities in WA's Kimberley region.

Conclusion
Reflexivity is necessary when working in a cross-cultural context. In Aboriginal homeland communities situated in remote settings, researchers benefit from being ‘on the ground’ to enable trust and genuine relationships to be developed. Visits on Country provide a rich experiential learning experience and a space for story sharing and yarning. Cultural guidance and two-way learning partnerships with cultural mentors assist non-Aboriginal researchers in understanding and adhering to cultural protocols and community processes. Allowing sufficient time to build relationships and flexible timelines are important considerations when developing research grants and protocols.

So What?
Our findings demonstrate the importance of building genuine relationships and yarning on Country with Aboriginal communities to build health promotion knowledge together. Making meaning of health literacy can only evolve through two-way learning partnerships where Aboriginal people guide the process. Our research reveals a novel approach to developing meaningful health promotion initiatives and resources on Country that centralise local Aboriginal language, artwork and community context.

Australian Aboriginal people experience stressors from inequalities across crucial social determinants, including deep and entrenched disadvantage and exclusion. The impact of unaddressed historical issues is pervasive and intergenerational. The disproportionate rates of Aboriginal youth suicide, juvenile detention and imprisonment highlight the inadequacy of existing social and emotional wellbeing programs and services for Aboriginal children and young people. There is increasing recognition in Australia that aligning social and emotional wellbeing interventions with Western values and conceptions of mental health is one of the main barriers to service uptake among Aboriginal people. This suggests fundamental questions remain unanswered about what type of services effectively address the complex constellation of social-emotional and wellbeing challenges arising from intergenerational poverty and trauma. Yawardani Jan-ga is an Aboriginal-led, operated, culturally secure, Equine-Assisted Learning (EAL) project designed by and with local Aboriginal young people, community Elders, members, and experts to address the complex constellation of social-emotional, spiritual and wellbeing needs of Aboriginal children and young people, aged 6–26 years, across multiple communities in the Kimberley region of Western Australia. EAL is a strengths-based learning approach where participants work with horses’ inherent characteristics to learn transferable life skills, such as communication skills, self-awareness, and emotional regulation, to promote social and emotional growth and wellbeing. Although EAL has been previously used with Aboriginal children and young people internationally, they are yet to be widely used with Aboriginal people in Australia. Here, we describe the three subcomponents of the Yawardani Jan-ga implementation science project and the planned Participatory Action Research and phenomenological approaches to capture the distinctive experiences of participants and the local communities where the intervention is implemented. We anticipate that findings will build an evidence base that informs policy and practice by understanding key intervention elements of social and emotional wellbeing support for Aboriginal youth, how to incorporate Aboriginal worldviews across different stages of interventions, and how to capture impact best using culturally secure methods.

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 Streptococcus pyogenes (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. We aim to evaluate the implementation of the SToP Trial activities and understand the relationship between the trial methodologies and outcomes observed.

Methods
A trial evaluation framework was developed, with the aim to assess whether the SToP activities were implemented as intended, and to gain insights into the implementation and practice necessary to translate this project more broadly. The evaluation employed a multi-methods approach, drawing on both quantitative (metadata relating to type and frequency of project activities, survey results) and qualitative (interview and yarning) data. The evaluation aimed to assess the delivery of the program in terms of implementation, degree of impact, and context.

Findings
Nine Kimberley communities participated in the SToP Trial between September 2018 and November 2022. During visits at the end of Steps 1 and 2 (October 2021 and October 2022, respectively), 152 people including 46 community members, 69 school staff members, 29 clinic staff members and 8 other service providers participated in a combination of individual and group interviews/yarns. Findings indicate the SToP Trial and associated activities existed and were completed within a culturally complex context with competing health and socioeconomic priorities while retaining specificity to each involved community. Acceptance and uptake of community activities was high, reflected in a marked decrease in skin infection during the Trial period. Trial activities including increased skin surveillance, staff training, availability of study treatment, environmental health initiatives and health promotion could not individually be linked to this improvement in skin health.

Interpretation
The leadership and guidance of community leaders, families, and regional Kimberley partners contributed to the Trial succeeding in its intended delivery of activities. Similar projects should prioritise a co-designed community-wide, holistic approach to health issues.

Funding
This trial was funded by the WA Department of Health, Australian National Health and Medical Research Council (NHMRC), and Healthway.