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25 May 2023

 A James Cook University-based health research team has received a $470,000 grant to collaborate with Aboriginal and Torres Strait Islander communities seeking to create their own culturally appropriate tools to assess risk of chronic disease – and then develop their own prevention strategies, based on existing community strengths.

Funded by the National Health and Medical Research Council Medical Research Future Fund, the Healthy Aging Research Team (HART) has embarked on a two-year project with communities in the Torres Strait region to co-design both individual health screening tools and community-level interventions, incorporating 21st century technology and Indigenous research methods – apps and yarning.

“Strong Communities, Strong Health: co-designing chronic disease prevention in the Torres Strait” is comprehensive and all Torres Strait communities are welcome to be involved.

“The genesis of this project came from communities themselves,” said HART researcher officer and clinical dietitian, Mel Kilburn, who is completing her PhD on the project. “Communities in the Torres Strait have expressed a need for these tools and will play a central role in developing these and other interventions. There will be ongoing consultation with communities at every stage of the project.”

Currently, there is limited data on diet and none on physical activity habits in adult residents, despite the escalating rate of chronic diseases in the region, including type 2 diabetes, heart and kidney diseases, and dementia.

This crucial knowledge gap is partly due to the geographic isolation of many communities, as well as the lack of culturally appropriate health assessment tools, according to Ms Kilburn. This, in turn, has inhibited the development of sustainable health interventions that are relevant and acceptable within communities.

HART is well-placed to bridge the gap. Launched in 2015, the team includes geriatricians, a dietician, physiotherapist, clinical neuropsychologist, clinical psychologist, occupational therapist, exercise physiologist, Aboriginal and Torres Strait Islander researchers, and PhD and post-doctoral researchers.

Many of the team members work for local health services and have longstanding relationships with Torres Strait and Northern Peninsula communities through their clinical outreach activities. All share a commitment to improving health systems and healthcare delivery to these communities, particularly to older residents who may require additional health support to stay in their communities.

HART currently has several projects in the region, under the umbrella project, Framework for Healthy Ageing. The team has an established Knowledge Circle, comprised of Aboriginal and Torres Strait Islander health professionals, Elders and community members across the region, to inform and guide HART projects.

Community feedback from previous projects made it clear that “Strong Communities, Strong Health” should adopt a strengths-based approach to developing chronic disease health assessment tools and prevention measures – identifying, and building upon existing cultural assets, including traditional foods and activities.

“Instead of what’s going wrong, communities want to know what’s going well; what is supporting people to live healthy lives,” said Ms Kilburn.

“In order to find out, they want lifestyle tools that provide immediate feedback to the respondent. Data that can then be de-identified and used to inform the development of community-wide interventions – all from a strengths-based perspective.

“That means recognising the inherent optimism, capabilities, and competencies of these communities and for us, as a research team, providing research and clinical skills to help them pursue this health agenda.”

Phase one of the project – the co-design and validation of app-based diet and exercise screening tools – is already well advanced. Drafted with the assistance of community feedback from a previous project, and additional community input along the way, the apps are now ready for piloting.

Unlike standard screening tools, they include questions about the intake of traditional foods found in the region, as well as standard supermarket fare, and reference cultural activities, such as dancing, among physical exercise options.

“With the apps, we really need to get the full spread of foods and activities common in region, because there are many supportive of good health. Diet-wise, this includes nutritious local fruits such as cooking bananas and bell fruit, as well as several different species of sardines,” said Ms Kilburn.

To ensure the apps are user friendly, questions are accompanied by visual images and users can also choose to hear the questions recorded in Torres Strait Creole, a language commonly spoken across the region. The project will recruit 122 Aboriginal and Torres Strait Islander people, via concurrent HART projects, to trial the apps and help researchers validate the content.

Data gleaned via the apps will be de-identified and used to detect dietary and activity patterns within the Torres Strait, from geographic areas down to individual community trends.

The second, desk-based, phase of the project will map environmental influences on health in communities, including access to facilities such as transport, supermarkets, and sport and recreation venues, as well as health services. Key community stakeholders, such as local community service agencies and local government departments, will also be interviewed.

As health is a holistic concept for Aboriginal Torres Strait Islander people, phase three of the project – “the final piece of the puzzle” – will focus on holding yarning circles in communities to establish their views on what supports good health and ageing.

Next year, the fruits of this extensive research journey will culminate in phase four – a series of co-design workshops with communities to develop chronic disease intervention strategies tailored to meet their needs.

“We will sit down with each community to share the findings with their particular community so they can workshop ideas for programs and strategies that support healthy lifestyles,” said Ms Kilburn. 

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