BACKGROUND:Aboriginal Australians experience a disproportionate burden of acute coronary syndrome (ACS), contributing to health disparities. Evidence on changes in ACS incidence is limited. This study investigates temporal changes in the gap between Aboriginal and non-Aboriginal populations in ACS incidence and case fatality within the context of the Closing the Gap initiative, a national policy framework to reduce inequalities. METHODS:This population-based cohort study used linked hospital and mortality data for Western Australian residents aged 25 to 84 years. Incident ACS cases (2003-2020) were identified using a fixed 18-year lookback. Age-standardized incidence rates were calculated using prevalence-adjusted denominators and direct standardization. Average annual percentage changes in incidence, case fatality, and Aboriginal-to-non-Aboriginal incidence rate ratios were estimated from Poisson regression, stratified by sex and age-group (25-54, 55-84 years). Estimates were derived separately for pre-Closing the Gap (2003-2008) and post-Closing the Gap periods (2009-2016; 2017-2020). RESULTS:The annual at-risk population was 1 215 300 in 2003 and 1 765 564 in 2020. We identified 4097 Aboriginal (mean age: 52.3, 40.8% women) and 64 805 non-Aboriginal (mean age: 65.1, 31.3% women) incident ACS cases. Aboriginal people had a higher prevalence of diabetes (58.5% versus 26.4%) and chronic kidney disease (27.5% versus 10.9%). ACS rates declined across all Aboriginal age/sex groups, although only significant between 2009 and 2016 for older men (-4.9%/y [95% CI, -8.9% to -0.7%]) and younger women (-4.8%/y [95% CI, -8.7% to -0.7%]). There were limited changes in incidence rate ratios between 2003 to 2008 and 2017 to 2020, respectively, in men (25-54 years, 5.2-5.6; 55-84 years, 2.9-2.1) and women (25-54 years, 10.3-10.0; 55-84 years, 2.9-3.6). Case fatality remained 20% to 50% higher among Aboriginal than non-Aboriginal people across periods and age-sex strata (risk ratios, 1.2-1.5). CONCLUSIONS:Despite some evidence of declines in ACS incidence among Aboriginal groups, disparities with non-Aboriginal people persisted. Sustained Aboriginal-led efforts are needed to address underlying determinants and reduce the gap.

Aboriginal populations in the Kimberley region of Western Australia are increasingly living well into older age. However, with population ageing comes a known increase in the prevalence of age-related conditions, including dementia. This paper examines ageing and dementia for Aboriginal people in the Kimberley 2021–51. Australian Bureau of Statistics Census data (2011, 2016 and 2021) were modelled using the Wilson-Grossman variation of the Hamilton-Perry projection method (Hamilton and Perry 1962; Wilson and Grossman 2022) to estimate the size and age structure of the Aboriginal population in the Kimberley. To determine the number of people living with dementia during 2021–51, estimates were modelled from prevalence rates reported in a Kimberley dementia cohort study by Smith et al. (2008) and self-reported rates from the 2021 Census. It was found that the Aboriginal population in the Kimberley is projected to grow by approximately 45% for the period 2021–51 from 20,245 people to 29,276, with the greatest growth in older age groups, particularly 85 years and older. Dementia prevalence scenarios (5%, 10% decrease, fixed, 5% and 10% increase) project the number of Aboriginal people living with dementia in the Kimberley will at least double by 2051. In the scenario of a 10% increase in dementia prevalence, a 3.5-fold increase is projected. As part of research knowledge exchange, a data literacy session was conducted with the Kimberley Healthy Adults Project: Indigenous Elders Data Governance group, where these data were presented and Elders' advice around sensemaking and interpretation was sought. Elders emphasised their concerns around the findings and highlighted the important implications of these data in the planning and delivery of health, social and aged care services, workforce, and policy, now and into the future.

Australia’s Aboriginal Community Controlled Health Organizations are under-resourced and too few. As a result, older Aboriginal and Torres Strait Islander peoples needing dementia-related care frequently receive services from mainstream organizations and non-Indigenous care providers unfamiliar with or unsure about providing culturally safe care. This paper presents reflections of Aboriginal Elders following their initial visit to a rural mainstream residential care community in Trouwerner/Lutruwita (Tasmania) prior to initiating an innovative series of podcasts and vodcasts focused on culturally safe care. Elders spent two days to appreciate and learn about the area and then two days at the residential care community, beginning with a Smoking Ceremony. Elders yarned with staff, individually and in small groups, moving freely about the center. Elders then met to yarn and de-brief. Thematic analysis identified both positive and challenging issues. Six themes were identified: (1) Importance of truth telling, (2) Value of staff interest, (3) Impact of the Smoking Ceremony, (4) Appreciation of the care environment; (5) Lack of Acknowledgement and understanding, and (6) Contribution of an Elder-in-Residence program. Elders’ initial experiences and reflections provided valuable insight into the need for their project and important baseline data from which to measure its impact.

Menstrual health and hygiene are important to address both nationally and internationally for women's health equity, due to the known impacts on social participation, health and well-being, and the barriers that women who are from marginalized, or minority groups experience in accessing menstrual health resources and management. Evidence is scarce globally regarding the sociocultural influences on experiences of menstruation for Aboriginal women in Australia. This qualitative study utilized two yarning groups, separated according to younger and older age groups, conducted with 20 participants to explore the experiences of menstruation and engagement with healthcare providers for Aboriginal women in a metropolitan setting in Perth, Western Australia. The women's lived experiences highlighted the social and well-being impacts of menstruation, the generational and life course differences in experiences of menstruation, and the importance of implementing holistic approaches to support and address barriers to menstrual care and promote well-being. These findings can inform the international knowledge base surrounding sociocultural influences on menstruation and directions for place-based development of menstrual well-being resources. Additionally, women's health policy in Australia should account for the culturally specific and diverse needs of Aboriginal women related to menstrual health.

Introduction: Strong family networks or kinships are integral for overall health and wellbeing, and it is important for families to have the opportunity to build positive and supportive relationships together. In Australia, culturally safe and appropriate programs have the potential to help Aboriginal families to strengthen connections and improve overall physical, social and emotional health and wellbeing. The Moordidjabiny Moort (Stronger Families) program was a place-based, culturally appropriate, family-determined health and wellbeing program, where families chose, planned, undertook and evaluated an activity with the aim of creating positive outcomes for their family. The program was delivered by the South West Aboriginal Medical Service, an Aboriginal Community Controlled Health Organisation that delivers a range of comprehensive primary healthcare services throughout the South West region of Western Australia. Central to this program was a holistic approach to support families and community by providing culturally responsive, community-led health promotion and prevention programs. However, Aboriginal Community Controlled Health Organisations are often limited due to funding constraints and reporting requirements that often do not cover outcome-based program evaluations. Thus, in addition to examining the impacts of the Moordidjabiny Moort (Stronger Families) program, the evaluation reported here also seeks to provide evidence to advocate for funding for similar programs in the future.Methods: Conducted as part of an internal program evaluation and culturally safe research-capacity-building learning experience for staff, the study implemented an evaluation design with embedded participatory action research and Aboriginal Data Sovereignty principles. Evaluation data included family activity grant application information and participant activity reports. Yarning circles and individual yarns were conducted with available program participants and staff and thematically analysed. A program logic model guided the development of outcome measures.Results: The activities provided healing, connection, and improved social and emotional wellbeing, and highlighted the importance of self-determination and cultural ways of working. Findings also show the value of a program logic that connects purposes and outcomes in program planning and evaluation. Added costs, organisation stresses and limited planning lead time are potential barriers to the implementation of this type of program.Conclusion: Both the organisation and the families involved in the project were able to determine how the project would be implemented and therefore ensured the needs and priorities of those involved were identified and met. Allowing families to determine their own outcome measures demonstrates on a small scale the empowering value of applying Aboriginal Data Sovereignty principles. Connecting purpose, planning and evaluation highlighted the value of self-determination, and the application of Aboriginal Data Sovereignty 'governance of data' principles. Comprehensive primary healthcare services that provide a holistic range of services in a culturally sensitive manner are particularly valued by Aboriginal people living in regional, rural and remote areas who would otherwise have been difficult to access. Aligned with the principle of 'data for governance' it is hoped that the learnings from this evaluation will inform funding models to allow Aboriginal Community Controlled Health Organisations greater determination regarding ways to deliver and evaluate programs using the methods and measures they choose.

Background: In partnership with Aboriginal Elders and Aboriginal community-controlled organisations, we developed a dementia risk management and prevention program for Aboriginal Australians aged >= 45 years. In this study, we report neuropsychological assessment data for people who underwent eligibility screening and baseline assessment and explore associations between the cognitive assessment tools used. Methods: Fifty Aboriginal people living in metropolitan Perth, Western Australia without known dementia were assessed with the Kimberley Indigenous Cognitive Assessment dementia screening tool (KICA-Cog) and a battery of standard neuropsychological tests. Results: Participants were aged 45-80 years (mean 63.5; standard deviation [SD] 9.4 years). Eleven participants (22.0 %) were male and 39 (78.0 %) were female. Of 49 participants with complete data, 13 (26.5 %) had a GAD7 score indicating a possible anxiety disorder and 20 (40.8 %) had a KICA-Dep score indicating possible depression. All participants were screened with the KICA-Cog and 44-49 were screened with the other tests. The mean KICA-Cog score was 37.2 (SD 1.7; range: 33-39) and the mean Montreal Cognitive Assessment (MoCA) score was 22.2 (SD 4.5; range: 13-30). There were moderate correlations between the KICA-Cog and MoCA, Symbol Digit Modalities Test (oral version), and Hopkins Verbal Learning Test total immediate recall and delayed recall scores. There were weak or no correlations between the KICA-Cog and other cognitive assessment tools. Four participants had previously been told they had cognitive impairment. The KICA-Cog and MoCA scores for these participants were 37.0 (SD 2.2; range: 34-39) and 18.8 (SD 1.5; range: 17-20), respectively. Discussion: A high prevalence of possible depression and anxiety suggest mental health support may be required for people participating in dementia prevention programs. The KICA-Cog is the only valid screening tool for dementia in Aboriginal and Torres Strait Islander people, but its clinical utility could potentially be improved to better detect mild neurocognitive disorder.

BACKGROUND:Australian Aboriginal children experience dental decay at more than twice the rate of non-Aboriginal children. The Select Committee into the Provision of and Access to Dental Services in Australia noted that the rate of potentially preventable hospitalizations was the highest among children aged between 5 and 9 years and was higher among Indigenous Australians and those living in remote locations. The application of a silver fluoride (AgF) solution to decayed surfaces has been shown to be effective in stopping the decay process and reducing the occurrence of new decay but has been tested to a limited extent in the Australian context. OBJECTIVE:This study aims to evaluate the feasibility of using the skills of an Aboriginal health practitioner to undertake the application of AgF to carious primary molars to arrest the caries progression and prevent the occurrence of new caries among young Aboriginal children in remote communities. METHODS:This study is a cluster-randomized controlled trial with communities randomized and stratified based on caries level and water fluoridation status. The trial will recruit 640 children (aged between 6 months and 7 years) from 30 communities. Informed consent will be obtained. At baseline, each child in the intervention group will be examined by a calibrated examiner and subsequently by an oral health practitioner who will prescribe to an Aboriginal health practitioner the teeth to be treated with AgF. A formulation with 38% AgF will be applied for 1 minute (0.004 mL per tooth). The control group will be provided with standard minimally invasive care. Participants will be followed annually for 2 years to assess caries arrest and prevention by blinded calibrated examiners. Child oral health-related quality of life and dental anxiety will be elicited through validated questionnaires. Tests of proportions will be used to evaluate the proportion of lesions arrested and the proportion of surfaces at risk that decayed over the follow-up. Multiple logistic regression with appropriate control for clustering of teeth and communities will be used to evaluate caries arrest, controlling for potential confounding factors. RESULTS:Community engagement has commenced, and data collection protocols have been prepared. Staff specific to the study (eg, Aboriginal health practitioners or workers) are in the process of recruitment. Participant recruitment will commence in March 2026 and conclude in December 2026. Study outcomes will be reported at 12- and 24-month follow-ups. CONCLUSIONS:This study will test the effectiveness and feasibility of a non-oral health professional applying AgF to achieve caries arrest and prevention and validate clinical findings against digital imagery acquired on site. This pragmatic study will inform the development of suitable and accessible models of care for dental service provision in rural and remote communities in Australia. TRIAL REGISTRATION:Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12624000457549p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=387518&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):PRR1-10.2196/72227.

Purpose of research Data show that many Aboriginal and Torres Strait Islander peoples experiencing dementia receive services at mainstream health organizations and from non-Indigenous health care providers. It is imperative that non-Indigenous health care providers are educated about culturally respectful and safe care for Aboriginal and Torres Strait Islander peoples with dementia. The purpose of this research was to partner with Aboriginal Elders to co-design and implement an online unit on culturally respectful and safe care to educate non-Indigenous health care providers. Principal results Twelve Aboriginal Elders from four Australian states, along with state-based Aboriginal project officers, partnered with the national, interdisciplinary research team to co-create and co-deliver the 13-week unit. Elders formed a Governance Group to guide the research team and ensure the content, delivery and methods of assessment of the unit privileged the spirit, voices, and diverse cultures of Aboriginal and Torres Strait Islander peoples. A team of Aboriginal markers, including Elders and project officers, was established to evaluate students’ assessments. The unit commenced in late July 2024 with 375 students enrolled. Major conclusions Comments from both Elders and students affirmed the importance of Elders’ presence in the unit through their weekly zoom sessions with students and participation in evaluation of students’ learnings. Elders’ guidance in the co-creation and co-delivery of the unit has been recognized at program, college and university levels. The unit is available nationally and internationally through the online Diploma of Dementia Care offered by the University of Tasmania, Australia.

Objectives: Dementia is a global health issue. Although best-practice guidelines for detection and management of dementia exist for primary care, there is a pressing need for culturally appropriate resources to support care for Aboriginal and Torres Strait Islander people living with cognitive impairment and dementia. Methods: A best-practice guide (BPG) for cognitive and dementia care for Aboriginal and Torres Strait Islander people attending primary care was developed incorporating evidence-based clinical care recommendations and cultural dimensions. Adopting research approaches characterised by inclusivity and collaboration, guide development included: (i) a planning phase with stakeholders; (ii) literature review; (iii) a draft development phase; (iv) a modified Delphi (e-Delphi) process; (v) in-depth cultural review by the project's Indigenous Reference Group and health service staff; (vi) and final clinical review. Results: Stakeholders wanted a BPG that was: comprehensive, easy to follow and practical; incorporated cultural considerations and; took account of the ongoing effects of colonisation. A two-part e-Delphi process, completed by 39 and 31 purposively selected participants respectively, reached consensus on: guide aims; cultural principles for inclusion; detection processes; future planning; referral to specialist cognition and palliative care services. Cultural review resulted in further integration of cultural principles and recommended development of additional resources. Further minor modifications were made during the final clinical review for peak body endorsement. Discussion: A rigorous development and review process has resulted in a culturally adapted resource health professionals can use to guide care with Aboriginal and Torres Strait Islander patients at risk of or experiencing cognitive impairment or dementia.

ISSUES ADDRESSED:Menstrual health literacy is an important aspect of improved engagement, management and social participation linked to menstrual health and wellbeing. There is stark evidence surrounding culturally appropriate menstrual health literacy for Aboriginal women in Australia. METHODS:This scoping review sought to explore current menstrual health literacy programmes and resources in Australia with further interrogation of how these relate to Aboriginal women specifically. This project used the Joanna Briggs Institute (JBI) scoping review methodology to systematically map and explore menstrual health literacy programmes and resources in Australia and for Aboriginal women. CONCLUSIONS:Seven research articles and nine grey literature reports from Australia met the inclusion criteria. The grey literature was insightful in relation to community based and culturally appropriate approaches to improving menstrual health literacy. SO WHAT?: Further research is required to demonstrate how culturally safe menstrual health programmes and health literacy resources that address the psychosocial and cultural needs of Aboriginal women, can be appropriately co-designed, evaluated and adapted to the diverse geographical contexts, in partnership with and for Aboriginal women.

A co-designed, Aboriginal health practitioner-led dementia risk management program (DAMPAA) was implemented from 2021 to 2024 to address the growing concern of dementia among Aboriginal and Torres Strait Islander peoples in Western Australia. Key features of DAMPAA included group walking and yarning sessions incorporating health and well-being education twice a week, alongside a six-month home program. A theory of change framework guided a parallel process evaluation, co-developed with Aboriginal Community-Controlled Health Services and an Elders Governance Group. The evaluation involved two distinct groups: Elders who participated in the program and staff involved in its design and delivery. Qualitative data were collected through yarning interviews, focusing on the program's implementation and impact. A brain health program for Elders was highly valued. Through group walking and yarning, the program supported a deeper connection to Country and strengthened community connection enhancing social and emotional well-being for Elders as well as program staff. A key learning was the significance of an Elders-informed health program, delivered by local Aboriginal people at an Aboriginal Community Controlled Health Service, creating a space that strengthens connection and a sense of belonging for Elders. The process evaluation validated the importance of the DAMPAA program. The DAMPAA program and resources have since been integrated into Elders' health programs across all service partners, demonstrating its relevance and potential for broader application.

Background:Dementia and cognitive impairment not dementia (CIND) are under-detected amongst First Nations peoples attending primary care. This trial implemented a culturally adapted best-practice model of care to increase detection and optimise management of CIND/dementia. Methods:This closed cohort open-label, stepped-wedge, cluster-randomised trial recruited 12 Aboriginal community-controlled primary health care services (ACCHSs) across urban, regional and remote settings in Australia. ACCHSs were eligible to participate if they conducted annual health checks, engaged in continuous quality improvement processes and had ≥55 clients aged ≥50 years. After a baseline control period, four ACCHSs were scheduled to enter the intervention phase every six months. During the intervention phase, ACCHSs were supported to embed best-practice dementia care through staff education and practice change initiatives. Co-primary outcomes were: (i) documented detection of CIND/dementia and, (ii) evidence of uptake of the diagnostic pathway measured as presence of ≥2 of: use of cognitive assessment tools, relevant pathology investigations, neuroimaging, and/or referral of clients with cognitive concerns to specialist services. Data were analysed with mixed effects complementary log-log regression. This study was registered with the Australia and New Zealand Clinical Trials Registry, ACTRN12618001485224. Findings:Between September 2018 and January 2019, 12 ACCHSs were recruited, comprising a sample of 1655 ACCHS clients aged ≥50 years (mean 60.3 ± 8.2 years), of whom 935 (56.5%) were female. One ACCHS withdrew during the study. After adjustment for time, the intervention did not show evidence of an effect for the first co-primary outcome (detection of CIND/dementia): HR = 1.53 (95% CI 0.64, 3.65). However, the intervention improved the second co-primary outcome (uptake of diagnostic pathway): HR = 2.34 (95% CI 1.05, 5.25). Intention-to-treat analyses yielded similar results. Interpretation:The co-developed best-practice model of care for cognitive impairment and dementia for Aboriginal and Torres Strait Islander people attending primary care improved the diagnostic CIND/dementia management process. Funding:National Health and Medical Research Council (Australia) and Dementia Training Australia.

CONTEXT:Comprehensive Primary Health Care (CPHC) is an interconnected, holistic, and strengths-based health and wellbeing approach fundamental to Aboriginal Community Controlled Health Organisations (ACCHOs) in Australia. However, policy and funding trends increasingly threaten the capacity of ACCHOs to deliver CPHC by imposing burdensome administrative and accountability requirements. A central constraint is the marginalisation of culturally informed data measures and tools that could enable improved development, implementation, evaluation and reporting of CHPC services and programs. To mitigate this, ACCHOs must be enabled to take charge of collecting and using meaningful data to increase self-determination and drive impactful policy and service delivery. Central to this approach is the capacity, skills, and infrastructure to collect and use culturally informed data and tools that align with community needs and organisational imperatives. MATERIALS AND METHODS:This project will undertake an Aboriginal participatory action research (APAR) mixed methods developmental evaluation approach to Aboriginal Data Sovereignty (ADS) initiatives. The project will be conducted both centrally and across the regional sites of the South West Aboriginal Medical Service (SWAMS), an ACCHO in regional Western Australia. Activities to initiate the APAR process include the development and training of a Community Research Panel to lead/facilitate APAR projects. A series of regional workshops will be held to build data literacy (including regional population health data) and identify innovative culturally-informed health and wellbeing data measures and tools for selected health priorities. Project team Aboriginal academic researchers and Aboriginal researchers at SWAMS will ensure the inclusion of Aboriginal research methods (Aboriginal ways of knowing, being and doing). Data collection will include both quantitative and qualitative data which will be analysed to identify the enabling processes and community and organisational outcomes as they align to the principles of ADS. DISCUSSION AND NEXT STEPS:The protocol herein describes the first phase of a two-phase project, where the second phase will implement the new and/or adapted data measures and tools established in phase one of the project. This project will build capacity towards evidence-based decision making by ACCHOs and support self-determination by enabling local, real-time evaluation of the integrated models of care that ACCHOs deliver.

INTRODUCTION:We aimed to explore the performance of the Kimberley Indigenous Cognitive Assessment - Cognitive component (KICA-Cog) and the Clock Drawing Test (CDT) in older Aboriginal and Torres Strait Islander adults with dementia and without dementia in the Let's CHAT Dementia study. METHODS:In this cross-sectional diagnostic test accuracy study, participants completed Comprehensive Geriatric Assessments. Demographic, health, cognitive, and functional histories, and cognitive assessments (KICA-Cog and CDT) were recorded. The reference standard was consensus diagnosis by two geriatricians blinded to KICA-Cog and CDT performance. Binary logistic regression and receiver operating characteristic curve analyses explored accuracy against a diagnosis of dementia. RESULTS:Seventy-five adults with a median age of 74 years (interquartile range 65, 78) were assessed, of whom 39 (52.0%) were women. Forty-seven (62.7%) had normal cognition, 15 (20.0%) had cognitive impairment no dementia, and 13 (17.3%) had dementia. Sixty-one (81.3%) participants had completed primary school, and 13 (17.3%) had completed secondary school. People with dementia were older (p = 0.046), but no differences were found for gender, comorbidities, or education. KICA-Cog and CDT scores were inversely associated with dementia in unadjusted and fully adjusted models (adjusted odds ratio [OR] = 0.43, 95% CI [0.26-0.71] and OR = 0.18 [0.07-0.51], respectively). The KICA-Cog was superior to the CDT for classifying dementia in participants, with area under the curve (95% CI) = 0.98 (0.95-1.00); versus 0.79 (0.64-0.93), respectively, p < 0.001. The optimal KICA-Cog cutpoint for classifying dementia was ≤34, with 92.3% sensitivity and 90.3% specificity. CONCLUSIONS:KICA-Cog is superior to CDT at classifying dementia when used with older Aboriginal and Torres Strait Islander adults and should, therefore, be prioritised over the CDT for cognitive screening in older Aboriginal and Torres Strait Islander peoples.

Purpose Aboriginal community-controlled organisations (ACCOs) play a significant role in meeting the needs of local community members. The COVID-19 pandemic particularly impacted First Nations communities in Australia. This study focused on describing the importance of ACCOs in the context of providing support to their local communities during the COVID-19 pandemic. This study also explored the impact that the pandemic had on the wellbeing of staff in ACCOs. Methods This study used a mixed methods approach, where a survey was distributed and interviews were conducted with staff members who worked in ACCOs across the south-eastern coast of New South Wales, Australia. The survey was completed by 46 clinical and administrative staff members. The survey explored connection to place, the impact that COVID-19 had on the organisation, service delivery and staff members. A subsection also investigated staff attitudes toward COVID-19. Semi-structured interviews were conducted with 42 management and executive staff members. Interview topics examined how ACCOs differ from mainstream services and how services responded to COVID-19. Main findings This study found that organisations, service delivery and staff were impacted by the COVID-19 pandemic. The ACCO sector responded to the pandemic by adapting to meet the complex and changing needs of the local First Nations community. The ACCO sector has a unique approach to service provision, including governance systems, relationships with community and connection to place, which enabled the sector to keep community safe. The ACCO services involved in this study adapted service delivery in innovative ways and remained focused on providing care for community. However, staff were impacted during this response, which was made more challenging as they were also managing additional stressors in their home lives. Principal conclusions The findings described the unique qualities of the ACCO sector and how the sector continued to provide culturally safe and place-based services across the south-eastern coast of New South Wales during the COVID-19 pandemic. Further research is needed to understand how to best support staff members in ACCOs during times of crises.

Introduction Although Aboriginal and Torres Strait Islander peoples are increasingly living healthier and longer lives, they continue to experience a high prevalence and incidence of dementia and cognitive impairment. Navigating dementia care services is challenging, and there is limited availability of flexible, culturally secure health and community care services. The aim of this study is to use a culturally adapted patient journey mapping methodology to examine the lived experiences of Aboriginal and Torres Strait Islander Aboriginal peoples living with dementia/cognitive impairment and their carers navigating their care journeys.Methods and analysis The overarching principle guiding this project is cultural security, referring to the incorporation of processes such that the research will not compromise the cultural rights, values and expectations of Aboriginal and Torres Strait Islander peoples. In this three-phase participatory action research study, we will (1) formalise relationships with health and home care services as recruitment sites; (2) conduct research yarns (a culturally secure qualitative data collection tool) with Aboriginal and Torres Strait Islander peoples living with dementia or cognitive impairment and their carers about their experiences of healthcare including perceived barriers and enablers to high-quality care. Data collected in research yarns will be analysed using a modified framework approach to map patient journeys and; (3) make recommendations for improving care identified by participants to be discussed and refined with stakeholder groups and to inform best practice guideline development.Ethics and dissemination This project follows the National Health and Medical Research Council’s guidelines for ethical conduct in research with Aboriginal and Torres Strait Islander communities and has been designed with active involvement and governance by Aboriginal and Torres Strait Islander peoples. The results will be disseminated through community feedback sessions, newsletters, conference presentations, peer-reviewed publications and best practice guidelines. Dissemination will also be guided by an established Aboriginal Reference Group.

The Good Spirit, Good Life (GSGL) assessment tool was co-developed in urban and regional Australia to address quality of life (QoL) for older Aboriginal and Torres Strait Islander peoples and inform culturally responsive care. This study aimed to determine the acceptability and validity of the GSGL tool in Australian remote settings. A co-design methodology was applied to this study. Yarning groups were conducted in 5 communities across 2 remote regions of Australia with older Aboriginal and Torres Strait Islander people. Required adaptations to the tool were refined with governance groups in each region. Forward and back translation was performed for the adapted tool with consensus achieved through an expert committee. Adaptations to the GSGL tool involved small wording changes to two items (Country/Island Home and Elder role). Five items were adapted through additional prompts and examples (culture, respect, supports and services, safety and security, basic needs). The remaining five items were retained (family and friends, community, health, spirituality, future planning). During forward and back translation, translation errors were identified with an expert language committee highlighting the importance of clear translation methods. The adapted GSGL tool is an acceptable QoL tool for use in health and aged care with urban, regional and remote-living Aboriginal and Torres Strait Islander Australians. When translating a tool, forward-back translation with an expert language committee is recommended to reach concordance in meaning. The adapted GSGL tool is suitable for use with an interpreter when required.

OBJECTIVE:Aboriginal and Torres Strait Islander peoples experience high rates of dementia, cognitive impairment not dementia (CIND) and associated risk factors. The objective of this paper is to outline baseline audit results of documented dementia, CIND and associated risk factors in patients attending Aboriginal Community-Controlled Health Organisations (ACCHOs). METHODS:Twelve ACCHOs in urban, regional and remote locations across Queensland, New South Wales, Victoria and Western Australia participated in the study. A specialised audit tool identified documented CIND, dementia and risk factors. Medical record audits of 1655 clients aged 50 years or older for the period from 1 September 2016 to 31 January 2019 were completed. RESULTS:The mean age of patients was 60.3 ± 8.2 years, and 57% were female. The overall prevalence of documented CIND or dementia was low, noted for only 67 (4%) patients. The prevalence of risk factors was high, with over two thirds (71%, n = 1168) of the cohort having ≥4 risk factors associated with dementia and CIND. These included high rates of hypertension (56%), diabetes (45%), dyslipidaemia (48%), obesity (40%) and current smoking (42%). CONCLUSIONS:There was a low detection of CIND and dementia accompanied by a high prevalence of associated risk factors in this primary health-care setting. These findings highlight the need to improve dementia and CIND detection in Aboriginal and Torres Strait Islander patient groups across varied geographical settings. The findings also provide insights into risk factor prevalence to inform management strategies. Responsive models of cognitive care that are culturally appropriate and co-designed with ACCHOs are required to address this need.

Purpose The Good Spirit, Good Life (GSGL) framework is a culturally informed quality of life (QoL) model co-designed with and for older Aboriginal people in Australia. The framework comprises twelve domains: family and friends, Country, community, culture, health, respect, safety and security, supports and services, Elder role, spirituality, future planning, and basic needs. The framework has been validated for urban and regional-living older Aboriginal people. It is unknown if the framework is valid in remote-living Aboriginal and Torres Strait Islander populations. This study aimed to determine the acceptability of the GSGL framework for older Aboriginal and Torres Strait Islander people living in remote areas and explore how the GSGL factors contribute to the QoL of this population. Methods A qualitative co-design study was conducted in five communities in the remote Kimberley and Torres Strait regions of Australia. Eight yarning groups comprising 36 people explored participants’ views about the framework. Data were analysed using thematic analysis. Results All participants agreed that the GSGL framework broadly reflected the Indigenous conception of what it means for older Aboriginal and Torres Strait Islander people to have a good life. Participants in the Torres Strait felt that the connection to Country domain did match in conceptualisation, although the term Island Home was preferred. Participants in the Kimberley region reported that no changes were required. Conclusions The GSGL framework, with a minor adjustment to include Torres Strait Islander perspectives, has been found to reflect the quality of life needs of older Aboriginal and Torres Strait Islander peoples living in urban, regional, and remote areas. The GSGL framework can be applied to inform planning and delivery of health and aged care to support the culturally informed quality of life needs of older Aboriginal and Torres Strait Islander peoples Australia-wide.