Collaborative Social-Epidemiology: A Co-analysis of the Cultural and Structural Determinants of Health for Aboriginal Youth in Victorian Schools

Abstract

Social-epidemiology that excludes Aboriginal voices often fails to capture the full and complex social worlds of Aboriginal people. Using data from an existing co-designed Victorian government Adolescent Health and Wellbeing Survey (2008/9), we worked with Aboriginal organizations to identify data priorities, select measures, interpret data, and contextualize findings. Using this participatory co-analysis approach, we selected “cultural” and “structural” determinants identified by Aboriginal organizations as important and modelled these using principal component analysis. Resulting components were then modelled using logistic regression to investigate associations with “likely being well” (Kessler-10 score < 20) for 88 Aboriginal adolescents aged 11–17 years. Principal component analysis grouped 11 structural variables into four components and 11 cultural variables into three components. Of these, “grew up in Aboriginal family/community and connected” associated with significantly higher odds of “likely being well” (OR = 2.26 (1.01–5.06), p = 0.046). Conversely, “institutionally imposed family displacement” had significantly lower odds (OR = 0.49 (0.24–0.97), p = 0.040) and “negative police contact and poverty” non-significantly lower odds (OR = 0.53 (0.26–1.06), p = 0.073) for “likely being well”. Using a co-analysis participatory approach, the voices of Aboriginal researchers and Aboriginal organizations were able to construct a social world that aligned with their ways of knowing, doing, and being. Findings highlighted institutionally imposed family displacement, policing, and poverty as social sites for health intervention and emphasized the importance of strong Aboriginal families for adolescents.

The Health and Wellbeing of Indigenous and Tribal Peoples around the Globe: Ensuring and Promoting Best Practice in Research

“…A range of mechanisms across the life of the research project or program, from setting research priorities to ongoing communication to dissemination of results, were described. These included: membership of Indigenous and Tribal people on advisory groups, working groups, steering committees, and governance committees [ 7 , 9 , 10 , 11 , 13 , 14 , 15 , 16 , 23 , 25 , 27 , 30 , 32 , 33 , 34 , 37 ]; involvement of community Elders, other community leaders, and Tribal health centres [ 19 , 25 , 28 , 35 ]; formal and informal partnerships with Aboriginal Community-Controlled Health Organisations, Tribal health services and other community organisations [ 8 , 10 , 14 , 19 , 20 , 22 , 25 , 29 , 30 , 31 ]; hiring and training Indigenous research staff, especially from the relevant community/ies [ 7 , 9 , 10 , 13 , 16 , 18 , 23 , 35 ]; the use of community-based participatory research approaches, co-design, and consumer engagement and involvement [ 12 , 19 , 20 , 23 , 25 , 32 , 33 , 35 ]; and the involvement ...…”

“…In addition to approval by Human Research Ethics Committees and Institutional Review Boards, which are embedded within Western academic institutions, a range of other mechanisms for ensuring appropriate Indigenous and Tribal governance in research were described in the papers included in the Special Issue, such as: approval by a Tribal government, an Indigenous Ethics Committee (e.g., the Aboriginal Health and Medical Research Council’s ethics committee in New South Wales, Australia), or an Aboriginal Community Controlled Health Organisation [ 7 , 8 , 9 , 10 , 12 , 13 , 14 , 16 , 18 , 19 , 22 , 23 , 25 , 28 , 29 , 31 , 35 ]; the use of cultural reference groups and governance committees [ 11 , 13 , 16 , 19 , 23 , 25 , 27 , 33 , 34 ]; and having formal agreed Terms of Reference and/or Resolutions of Support [ 10 , 20 , 29 ].…”

“…Some authors specifically mentioned aspects of data governance and data sovereignty, such as Tribal/community ownership of data, approval of manuscripts for publication, establishment of a data governance committee, and reference to specific data sovereignty principles [ 10 , 11 , 20 , 26 , 27 , 28 , 30 , 35 ]. For example, Ward and colleagues [ 35 ] sought to understand the role of land in the wellbeing of Labrador Innu people.…”

“…Other studies reflected the priorities of government agencies, either through alignment with articulated strategies or through commissioned work [ 24 , 25 , 33 ]. Many studies reflected the expressed needs and priorities of Indigenous and Tribal communities, either directly or through community organisations, Tribal governments, and/or Indigenous/Tribal advisory committee members [ 7 , 8 , 10 , 12 , 14 , 19 , 20 , 22 , 23 , 28 , 30 , 31 , 33 , 34 , 35 ].…”

“…The resulting Special Issue includes 31 papers in total, with 21 from Australia [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ], 4 from the United States [ 28 , 29 , 30 , 31 ], 3 from Aotearoa/New Zealand [ 32 , 33 , 34 ], 1 from Canada [ 35 ], and 2 from authors in multiple countries [ 36 , 37 ]. This represents a substantial body of research on the health and wellbeing of Indigenous and Tribal peoples, possibly the largest collection ever published.…”