Karla Canuto

Despite decades of policy focus, Aboriginal and Torres Strait Islander men still face primary health care systems that are misaligned with their cultural and social needs, leading to low use. A strong body of evidence shows engagement improves when care is culturally safe, gender‐responsive and community‐led, yet these are inconsistently implemented. Short‐term funding and fragmented commissioning undermine continuity, workforce stability and holistic care. Reliance on pilot programs reflects risk aversion and limits reform. Redesigning commissioning to ensure long‐term funding, a stable workforce, stronger governance and learning‐focused evaluation is essential. Continued delay perpetuates inequity, making reform an ethical and political imperative.

First Nations, or Indigenous, peoples are a diverse group of hundreds of millions of tribal peoples globally. First Nations perspectives of health differ from biomedical models and include the interconnectedness of Country, people, and culture, requiring a holistic approach that integrates traditional knowledges and practices. Traditional physical activity practices are evident in First Nations cultures, some with localised cultural significance. This chapter will describe data on First Nations physical activity rates and the unique physical activity perceptions and influences for First Nations peoples and will provide evidence and examples of successful physical activity initiatives for First Nations peoples. It will conclude with a commentary on research gaps and future directions, offering practical recommendations for researchers, practitioners, and policymakers.

Background: Out-of-pocket healthcare expenditure (OOPHE) drives health inequities for Australian First Nations Peoples, particularly in rural and remote areas. While financial barriers are well documented, less is known about the cultural, social and emotional consequences of travelling away from Country for healthcare. Methods: Aboriginal yarning methodologies informed by Knowledge-Interface approaches were used across eleven yarning sessions with 22 Aboriginal participants living on Kokatha, Mirning and Wirangu Country in the Far West of South Australia. Data were analysed thematically through deep listening and iterative coding, guided by Aboriginal researchers and an Aboriginal Governance Group. Findings were presented through three consolidated stories to maintain relational meaning, cultural integrity, and participant voices. Results: Participant stories revealed how repeated travel for healthcare creates cumulative financial, cultural, and emotional consequences. Leaving Country disrupted kinship networks, reduced cultural safety, and exposed participants to unfamiliar and culturally unsafe environments, contributing to distress and erosion of identity during periods of vulnerability. For many, these impacts led to delayed, rationed, or forgone care. Discussion: This study extends existing OOPHE literature by foregrounding cultural disconnection as a central mechanism shaping healthcare access. These impacts are fundamental, shaping decisions about when, how and if care is sought, contributing to ongoing inequities and extended periods off Country. Conclusion: Travelling for healthcare is not simply a logistical or financial challenge but a deeply personal and culturally disruptive experience. Addressing OOPHE requires system-level reform that prioritises culturally safe and locally delivered care and supports on Country.

BACKGROUND Co-design ensures cultural safety of health interventions for Aboriginal and/or Torres Strait Islander communities. However, an intervention developed with one Indigenous community may not be suitable for another geographically and culturally distinct community. OBJECTIVE This study aimed to culturally adapt content and features of a mobile health (mHealth) application co-created by communities in one Australian state to better meet the needs of mothers and caregivers of Aboriginal and/or Torres Strait Islander children aged 0-18 years and health professionals in another state. METHODS The study followed the stages of the cultural adaptation stepwise model by Barrera et al. Mothers/caregivers of Aboriginal and/or Torres Strait Islander children aged 0-5 years and their health professionals were recruited from multiple community sites. Data were collected through culturally appropriate yarning circles or interviews facilitated by Aboriginal research staff. Qualitative data were transcribed and inductively analysed to generate themes. The feedback was translated into practical changes that were applied to the mHealth application. RESULTS Data saturation was achieved after yarning circles with 21 women and seven health professionals. Nine themes were generated from mothers/caregivers’ data: 1) cultural relevance and sensitivity, 2) linking with culturally appropriate services, 3) Use of lay language and more audio-visual content , 4) concerns with mobile data usage, 5) Perceptions about the current content of the Jarjums app, 6) raising children, 7) safety, 8) health and wellbeing of mothers and caregivers, and 9) coordinating health care. Four themes were generated from data collected from health professionals: 1) favourable features of the app, 2) potential barriers to the use of the app, 3) healthcare system access issues, and 4) recommended modifications. Based on feedback received, the mHealth application changes included the addition of information on healthy relationships and raising children, more visual content, and localized service directories for different categories of care and support. CONCLUSIONS A co-designed, culturally sensitive mHealth application is likely to support Aboriginal and/or Torres Strait Islander families facing health disparities due to disruption of Indigenous culture by a foundation for a potential clinical trial for effectiveness evaluation and wider implementation. INTERNATIONAL REGISTERED REPORT RR2-10.2196/53748

Out-of-pocket health expenditure (OOPHE) significantly impacts people with chronic and complex diseases (CCDs) and injuries. Aboriginal communities experience a higher burden of CCDs and injury, along with greater OOPHE inequities. This project aims to develop and implement a social prescribing digital platform (Web App) to reduce OOPHE. It is grounded in citizen science approaches that value the lived experience and knowledge of Aboriginal people in shaping solutions. The project uses a citizen science methodology adapted for these communities, using knowledge interface methodology to weave together Indigenous and Western knowledges. Research methods (Indigenous, quantitative, qualitative) explore the relational nature of OOPHE risks and protective factors through co-design and workshops with Aboriginal participants to develop the Web App. A community-centric developmental evaluation guides the trial and refinement of the platform, allowing for ongoing learning and adaptation. Process measures inform a national scale-up and evaluation framework. Addressing OOPHE is essential to improving health and wellbeing for Aboriginal and Torres Strait Islander individuals and families living with or at risk of CCDs. This initiative aims to reduce the impact of OOPHE through digital social prescribing, there by connecting people with essential community services to access healthcare, offering a scalable approach to addressing health inequities nationwide.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Mobile health (mHealth) interventions promoting healthy lifestyle changes offer an adaptable and inexpensive method for accessing health information but require cultural appropriateness and suitability for acceptance and effectiveness in Indigenous populations. No systematic review on effective mHealth interventions for Indigenous women during pregnancy and the early childhood years has been conducted. Objective: This review evaluated the effectiveness of mHealth interventions promoting healthy behaviors for Indigenous mothers and children from conception to 5 years post partum. It also aimed to explore the observed effectiveness differences based on participant engagement, intervention design, and provision of context. Further, the review explored if the interventions were co-designed. Methods: A systematic search of 5 databases was conducted: SCOPUS, MEDLINE, CINAHL, PsycINFO, and ProQuest (Dissertation or Thesis). Studies were included if they were either a randomized controlled trial, pre-post comparison, or a cohort study using mHealth with Indigenous women for maternal and child health following a preregistered PROSPERO protocol (CRD42023395710). HealthInfoNet was searched for gray literature and the reference lists of included studies were hand searched. The initial title and abstract screen for eligibility were performed by 1 reviewer. A full-text screen of eligible studies and a quality appraisal of included studies was performed by 2 reviewers independently. The appraisal tools used were the Mixed Methods Quality Appraisal Tool and the Centre of Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE). A descriptive synthesis of the extracted data was performed. Results: Of the 663 articles screened, only 3 met the eligibility criteria. Each paper evaluated a different mHealth intervention: Remote Prenatal Education; the SMS Parent Action Intervention (two-way text messaging); and the Screening, Brief Intervention and Referral to Treatment (SBIRT) eCHECKUP To Go (web-based screening and intervention). Statistically significant changes were reported in some outcomes, including an increase in the parental participation rate in face-to-face prenatal education; increased rate of breastfeeding initiation and exclusive breastfeeding (2-12 months); improved overall children’s behavior related to sleep, diet, physical activity, screen time, and intake of sugary beverages; improved individual children’s behavior related to physical activity and sleep; and decrease in alcohol drinks per week and binge drinking episodes per 2 weeks due to time effect. However, no study provided a sample size calculation for the reported significant outcomes. Also, due to the small number of included studies and each study evaluating a different intervention, it was not possible to combine results to ascertain if the participant engagement, intervention design, or community context had any impact on the effectiveness. Conclusions: Due to the lack of sample size calculation, it was not possible to establish whether differences in the effectiveness were due to the interventions or a type I statistical error. Therefore, caution is required in the interpretation of these findings. Trial Registration: PROSPERO CRD42023395710; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023395710

Background: There is limited evidence of high-quality, accessible, culturally safe, and effective digital health interventions for Indigenous mothers and babies. Like any other intervention, the feasibility and efficacy of digital health interventions depend on how well they are co-designed with Indigenous communities and their adaptability to intracultural diversity. Objective: This study aims to adapt an existing co-designed mobile health (mHealth) intervention app with health professionals and Aboriginal and/or Torres Strait Islander mothers living in South Australia. Methods: Potential participants include Aboriginal and/or Torres Strait Islander pregnant women and mothers of children aged 0-5 years, non-Aboriginal and/or Torres Strait Islander women who are mothers of Aboriginal and/or Torres Strait Islander babies, and health professionals who predominantly care for Aboriginal and/or Torres Strait Islander mothers and babies. Participants will be recruited from multiple Aboriginal and/or Torres Strait Islander–specific health services under the local health networks around metropolitan South Australia. In this study, data collection will be carried out via culturally safe, and family-friendly yarning circles, facilitated by Aboriginal research staff to collect feedback on the existing mHealth app from approximately 20 women and 10 health professionals, with the aim to achieve data saturation. This will inform the changes required to the mHealth app. All focus groups and interviews will be audio recorded and transcribed verbatim. Data will be inductively analyzed using realist epistemology via NVivo software (Lumivero). Themes about the mHealth app’s cultural acceptability, usability, and appropriateness will be used to inform the changes applied to the app. Results: With the feedback received from participating women and health professionals, changes in the smartphone app will be made to ensure the intervention is supportive and meets the needs of Aboriginal and/or Torres Strait Islander mothers and families in South Australia. Participation of community members will promote ownership, community engagement, and implementation. Conclusions: A co-designed, culturally sensitive, and effective digital health intervention is likely to support Indigenous mothers and their children facing health disparities due to the disruption of Indigenous culture by colaying a foundation for a potential clinical trial and wider implementation. International Registered Report Identifier (IRRID): PRR1-10.2196/53748