The Strong Families Study (SFS) is an Indigenous-led, longitudinal birth cohort study that supports Aboriginal and Torres Strait Islander families during the first 1000 days across Queensland, Australia. Its success lies in a co-design approach that embeds Indigenous leadership and culturally responsive methodologies throughout the research process. A co-design, workshop approach was undertaken in partnership with an Indigenous Steering Committee (ISC), providing leadership, Indigenous knowledge, experiences, and priorities. The Aboriginal practices of Dadirri, that is, inner deep listening and quiet still awareness, and Yarning, which facilitated meaningful discussions, were utilised and helped redress power imbalances between researchers and ISC members. Other strategies effectively incorporated sticker exercises, active discussions, and reaching consensus across the group. Key outcomes of the co-design included the development of culturally responsive health priorities, informed consent practices, and data collection and governance processes. The ISC prioritised self-determination and fostered ongoing, meaningful dialogue between researchers and community members, reinforcing the study's ethical foundations and culturally responsive approach. The co-design process ensured that Indigenous voices were prioritised and respected, enhancing the study's cultural integrity. Therefore, the SFS offers a model for Indigenous-led research, highlighting the vital role of Indigenous leadership and knowledge in shaping health research and outcomes.

Longitudinal, Indigenous-led research integrated with community-controlled continuity of care can improve and support perinatal outcomes for Aboriginal and Torres Strait Islander families in Australia. Across the past 35 years, seven cohorts have contributed complementary insights from pregnancy through early childhood with varying geographic reach and appropriate Indigenous governance. This paper discusses each of these cohorts and how these studies across pregnancy, birth and some continuing through early childhood, have substantially added to the body of knowledge related to perinatal health needs for women. Early cohorts (e.g., MUSP; Raine) advanced life‑course epidemiology but had low Indigenous representation, limiting perinatal inference for these communities. The Aboriginal Birth Cohort achieved exceptional long‑term retention and partnerships and from the late 2000s, Gomeroi gaaynggal enabled causation analyses using biomarkers. Finally, systems initiatives such as PANDORA and BiOC demonstrate successes with culturally safe pathways and Indigenous‑governed continuity models. Evidence suggests the approaches undertaken in the perinatal period must ensure the voices of Indigenous people are paramount particularly when care and research is being delivered to communities. Lessons learned from these cohorts highlight that Indigenous governance and workforce, co‑design and community‑embedded engagement enhance retention, relevance and translation; registries and continuity models deliver measurable outcome gains. The depth of knowledge identified in life-course research for Indigenous women can significantly add to the standard data collection tools used by state and national services.

Objective The Indigenous Measures for Protecting and Addressing Critical Trauma (IMPACT) project aims to transform trauma care for Aboriginal and Torres Strait Islander peoples by embedding Indigenous knowledges and culturally responsive practices into trauma systems. Methods Using Knowledge-Interface Methodology, the IMPACT will be implemented across two South Australian trauma sites through four phases: establishing trauma profiles and lived experiences; co-designing relational clinical quality indicators and patient-reported outcome measures; piloting and evaluating the program using RE-AIM QuEST framework; and translating findings into national trauma systems. Guided by an Aboriginal Governance Council, the project ensures Indigenous Data Sovereignty and community-led decision-making. Results IMPACT will lead to the co-design of relational clinical quality indicators and patient-reported outcomes that enhance cultural safety in trauma care for Aboriginal and Torres Strait Islander communities. Conclusion IMPACT will demonstrate improved cultural safety in trauma care, increased use of Indigenous-led quality indicators, and enhanced patient-reported outcomes. IMPACT will build capacity among Aboriginal researchers, foster clinical champions, and provide a replicable model for national reform. Implications for Public Health IMPACT lays the groundwork for developing culturally responsive quality of life tools tailored to priority populations, improving outcome measurement and advancing health equity.

Introduction Australian studies investigating parental factors often lack meaningful inclusion of Aboriginal and Torres Strait Islander families, limiting our understanding of current influences on positive developmental trajectories within communities. There is growing recognition of the need for culturally safe and responsive longitudinal research that is co-designed and co-led by the community for the community. An Indigenous-led birth cohort study of Aboriginal and Torres Strait Islander families in Queensland, Australia, has therefore been developed to better understand health across generations.Methods and analysis The Strong Families Study is a co-designed prospective longitudinal birth cohort study that will follow 400 Indigenous families in Queensland from pregnancy until the child reaches 5 years of age. Eligible participants include pregnant individuals (<28 weeks’ gestation) whose children may identify as Aboriginal and/or Torres Strait Islander, along with their partners (if applicable). Data will be collected at multiple timepoints: during gestation, at delivery, postpartum, every 6 months until the child is 36 months (corrected age, CA) and annually until age 5 years. These will be collected by Aboriginal health workers using validated and culturally appropriate tools across different health themes. The study will incorporate health literacy throughout, as well as referrals to two nested family support programmes to support families and assist with the developmental outcomes of their children when and if required. Effects across health themes will be analysed with a focus on strengths, positive trajectories and holistic well-being of Indigenous families, moving beyond deficit-based narratives.Ethics and dissemination This study was approved by the Mater Misericordiae Ltd Human Research Ethics Committee (HREC/MML/105191) and ratified by the University of Queensland Human Research Ethics Committee (2025/HE001924). Endorsement letters were secured from partner services at each study site. Findings will be shared with partnering hospitals and funding bodies at conferences and through reports and peer-reviewed publications.

Indigenous peoples remain under-represented in genomic research and clinical trials. This reflects historical exclusion, mistrust and health system barriers. In this article, we describe a single Australian institution's experience in improving engagement and enrolment of Aboriginal and Torres Strait Islander patients in a cancer genomic sequencing study. We reflect on challenges related to rapport, consent and enrolment and outline practical strategies including relationship-building, targeted resources and a tailored enrolment pathway. We contend that equitable participation in genomic research requires sustained, trust-based and culturally specific engagement, rather than reliance on purely technical or procedural solutions.

Patient-reported outcome measures (PROMs) are widely used in trauma and injury research to assess health-related quality of life (HRQoL), mental health and functional recovery. However, PROMs are rarely adapted to reflect the lived experiences, cultural values and determinants of health for priority populations, particularly Aboriginal and Torres Strait Islander peoples, who experience a disproportionate burden of injury in Australia. This systematic review addressed the inclusion of health equity indicators and Indigenous knowledges for PROMs used in observational Australian trauma and injury studies for adults (≥ 18 years). A systematic search of Medline (OVID), CINAHL (EBSCO) and Scopus was performed including prospective cohort or longitudinal designs, focused on trauma-related injuries conducted in Australia. Data were extracted and appraised using the CREATE and PROGRESS-PLUS tools to assess Indigenous engagement and equity-sensitive reporting. Across the 11 included studies, 17 different PROMs were used with SF-36 and PCL-C being the most common. Physical and mental health outcomes were consistently impaired post-injury, with long-term impacts. Equity considerations were largely absent; none of the studies met all PROGRESS-PLUS criteria and Indigenous knowledges were not incorporated. Priority populations, including Aboriginal and Torres Strait Islander peoples, culturally and linguistically diverse (CALD) communities, people with disabilities and women, were frequently underrepresented or excluded. These findings highlight significant gaps in equity-sensitive PROM use and the urgent need for culturally safe and inclusive PROM development that reflects diverse recovery experiences thereby supporting equitable trauma care and follow-up. This study looked at how injury research in Australia uses patient-reported outcome measures (PROMs) to understand recovery after injury. PROMs are tools that ask patients about their health and wellbeing, but they often don’t reflect the experiences or cultural values of Aboriginal and Torres Strait Islander peoples, who are more likely to be injured and face worse outcomes. We reviewed 11 studies and found that while 17 different PROMs were used, none were designed with or for Aboriginal and Torres Strait Islander communities. Most studies didn’t include key equity factors like race, language, disability, or gender in their analysis, and Indigenous perspectives were missing entirely. This means current trauma research may not correctly capture the recovery journeys of priority populations. Our findings show an urgent need to develop culturally safe and inclusive PROMs that reflect diverse experiences and support fairer trauma care. This work can help improve health outcomes and ensure that Aboriginal and Torres Strait Islander peoples are meaningfully included in future research and healthcare planning.

BACKGROUND:Aboriginal and Torres Strait Islander peoples experience persistent health inequities shaped by colonisation and its ongoing impacts, including racism, and structural and social determinants of health. Culturally safe tertiary education is essential for preparing a responsive health and human services workforce. OBJECTIVES:To explore shifts in undergraduate and post-graduate nursing, midwifery, and social work students' knowledge, attitudes, beliefs and learning experiences during a mandatory Cultural Safety and Indigenous Health and Wellbeing interdisciplinary course at an Australian university. METHODS:A sequential multi-method research design used a pre-and post-curriculum online survey (Ganngaleh nga Yagaleh) alongside open-ended qualitative questions. Quantitative data were analysed using non-parametric tests and mixed-effects models; qualitative responses were analysed using reflexive thematic analysis. RESULTS:Of 481 enrolled students, 182 (37.8%) completed all survey components. While no significant change was observed in Commitment to Culturally Safe Practice (coefficient 1.11, 95% CI -0.32-2.53, p = 0.13), significant improvements were found in Understanding of History and Power (co-efficient 2.59, 95% CI 1.55-3.62, p < 0.001), and Attitudes, Values and Beliefs (coefficient 3.44, 95% CI 1.95-4.92, p < 0.001). Qualitative findings demonstrated richer, more nuanced shifts: students moved from general awareness to more contextualised understandings of colonisation, systemic inequity and their own positionality. Many described emotional journeys characterised by discomfort, vulnerability, empathy, and renewed commitment to ethical and culturally safe practice, while others expressed resistance or uncertainty. Students emphasised the importance of Indigenous-led teaching, yarning-based learning environments and relational, reflective pedagogy in supporting transformative learning. These data also indicated the need for indigenising curriculum beyond one course to enable students' earlier exposure to racially determined negative health outcomes. CONCLUSION:The course fostered meaningful cognitive, emotional and reflective shifts in students' understandings of cultural safety. Findings emphasise the value of Indigenous-led, relational, and decolonising pedagogies and the importance of embedding cultural safety education earlier and more consistently across health curricula.

This study addresses the disproportionate incarceration of Aboriginal and Torres Strait Islander children in Australia by co-designing an Indigenous community-led, culturally responsive prevention framework. Building on three prior studies – a scoping review and two qualitative studies with Elders, community members, and children – the research employed an iterative co-design process grounded in Indigenist and decolonising methodologies. Participants engaged in single and group yarning interviews to refine framework components, ensuring alignment with cultural values and community priorities. The resulting framework, Transformative healing and Adungadoo pathways, comprises three interconnected levels: universal outcomes for thriving children, connected families and empowered communities, rights-based systemic reforms, and culturally grounded program elements across the life course. Findings highlight the need for holistic, healing-informed and strengths-based approaches that disrupt colonial drivers of child incarceration and promote self-determination. This work offers a practical, community-driven model for justice reinvestment and systemic transformation.

This qualitative research aims to empower Indigenous-led, self-determined transformative social change to liberate Aboriginal and Torres Strait Islander children from oppressive, racially discriminatory, and harmful incarceration practices. Using Indigenist and decolonising ontology, transformative epistemology, and participatory action research, data were collected through yarning interviews and analysed using reflexive thematic analysis. Eighteen participants included Elders, community members and stakeholders from Queensland, Australia. Six themes were identified, which addressed historical and socio-political issues, and racialised health and justice systems driving disparity and inequity impacting these children. The themes highlight ways to reduce punitive punishment and criminalisation of complex health and support needs by instilling healing, holistic, child and family-focused approaches. By identifying children’s strengths and challenges during crucial developmental periods, this research offers stories that inspire resistance to child incarceration, and empower hope, healing and freedom.

Background Aboriginal and Torres Strait Islander peoples hold deep cultural strengths, kinship structures, and knowledge systems that are central to health and wellbeing. Yet, health research in Australia has historically been dominated by deficit-based approaches, often overlooking Indigenous knowledges and leadership.Methods The Indigenous Health Research Priorities (I-Priorities) study aimed to prioritise Indigenous community voices in identifying health research priorities across Queensland, with a focus on early life, perinatal and family health. Using Indigenous Methodology and a participatory action research framework, communities across Far North, North, Central and South-East Queensland identified and refined their health research priorities. This was achieved in two phases: initial yarning sessions followed by Delphi workshops. Data were analysed thematically and validated through community review processes to ensure cultural integrity.Results The study engaged 403 participants through 40 yarning sessions and 13 Delphi workshops conducted between May 2022 and October 2024. The study included participants across diverse age groups, with 80.5% identifying as Indigenous. Communities consistently highlighted key health priorities, with an overwhelming number of participants identifying access to health services, particularly transport, affordability, and overcoming institutional racism. Social and emotional wellbeing, along with family and domestic violence, also emerged as top priorities. Overall, the findings affirm that Indigenous-led research provides solutions grounded in cultural strengths and guided by principles of self-determination.Conclusion The I-Priorities study offers a clear roadmap for aligning research, service delivery and policy with priorities defined by Aboriginal and Torres Strait Islander communities, fostering stronger beginnings, healthier families and intergenerational wellbeing across Queensland. Importantly, findings from communities underscore that health equity requires more than biomedical solutions and demands sustained investment in cultural, social and structural determinants of health.

Problem/Background Australian First Nations people experience disproportionate burdens of poor outcomes compared to non-First Nations people. Further, women living in remote communities face more barriers to care-seeking in pregnancy. Despite work being done in some remote communities, there is limited data exploring women's experiences of pregnancy care, thus a limited understanding of specific barriers and enablers to care-seeking for these women. Aim This study aimed to identify barriers and enablers to care-seeking during pregnancy for Australian First Nations women living in several remote communities in the Northern Territory, by listening to their stories. Methods Yarning, highly regarded and rigorous qualitative approach developed by and for First Nations peoples, was undertaken in several settings with women living in remote First Nations communities. Using purposive sampling, nine women participated. Findings Two themes emerged: (1) the importance of family and community for women's emotional wellbeing; (2). ways healthcare providers and services build trust with pregnant women. Discussion Women identified various family and community members as significant sources of support in community and while hospitalised, including having companions while away from home. Further, reduced access to community life impacted emotional wellbeing.Continuity-of-care throughout pregnancy was essential for building trust, as was responsive, clear communication. Intentional connection building by care providers enabled development of trust. Conclusion Providing culturally safe care will likely facilitate enablers and reduce barriers to care-seeking in pregnancy in remote communities. It requires ongoing and sustained efforts to ensure true partnership and collaboration between First Nations peoples and health services.

This Indigenous-led qualitative study explores the lived experiences of Aboriginal and Torres Strait Islander people involved in child justice systems, highlighting both protective factors and systemic challenges. Thirteen participants shared stories that revealed the importance of hope, identity, supportive relationships, and culturally safe spaces in fostering resilience and positive change. These strengths were often developed in the context of significant adversity, including early trauma, systemic racism, and harmful institutional responses. Sub-themes were organized under two overarching themes: Negative Childhood Experiences and Positive Influences and Protective Factors. Findings underscore the need for culturally responsive, strengths-based justice reforms that center lived experience and promote healing, belonging, and opportunities for Aboriginal and Torres Strait Islander children, families, and communities.

Purpose Australia has one of the highest incidences of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in the world, with a disproportionate disease burden on Aboriginal and Torres Strait Islander communities. This systematic review aimed to explore the effectiveness and cultural responsiveness of prevention programs to prevent, reduce and control RHD, to improve quality of life, and prioritise community engagement and empowerment. Methods A systematic review was conducted involving a comprehensive search of three databases (PubMed, Embase and CINAHL) and grey literature from Australian Indigenous websites and Google Scholar. Articles met inclusion criteria if they evaluated prevention programs, targeted ARF/RHD and centred Aboriginal and Torres Strait Islander communities in Australia. Data were extracted by three reviewers, and results were descriptively analysed. Study quality was appraised via the Mixed Methods Appraisal Tool and the Aboriginal and Torres Strait Islander Quality Appraisal Tool. Main findings Eleven peer reviewed articles were included. Prevention programs varied in their effectiveness and cultural responsiveness to reduce ARF and RHD. Overall, the studies scored higher for generalised methodological quality determined by the Mixed Methods Appraisal Tool than the measurement of cultural responsiveness via the Aboriginal and Torres Strait Islander Quality Appraisal Tool. Research engagement with Aboriginal and Torres Strait Islander communities addressed ways to improve screening strategies to identify ARF, awareness of RHD adherence to penicillin prophylaxis, community-led education and training, environmental health and community-centred traditional language to convey culturally responsive health messaging. Principal conclusions Further research is urgently needed in the provision of effective and culturally responsive prevention programs to reduce the incidence of ARF and RHD. Studies that centre Indigenous-led and community-based prevention programs that value self-determination, community agency and autonomy to advance holistic health and wellbeing for Aboriginal and Torres Strait Islander peoples offer promise in the elimination of ARF and RHD.

Despite the potential of evidence-based medical innovations to improve patient outcomes, their integration remains difficult. Implementation science aims to assist by identifying and deploying effective implementation strategies within complex health care settings. Determinant frameworks, such as the Consolidated Framework for Implementation Research (CFIR), help identify factors influencing implementation success but do not specify mechanisms or methods for selecting optimal strategies. Selection methods are largely empirical, highlighting the need for objective, quantifiable approaches. We developed causal Bayesian networks (BNs) to model the interdependencies amongst contextual factors, determinants and outcomes with a specific example: the detection and management of chonic wet cough in Indigenous Australian children in primary health care settings. The BNs, informed by CFIR domains and prior qualitative research, quantifies the impact of barriers and enablers on implementation outcomes. The BNs enable predictions of intervention effects, and the assessment and quantification of potential implementation strategies, or a combination of strategies. The BNs are linked to a simple survey that allows implementation strategies to be tailored for each setting and that was administered at several sites across Australia to validate the models. The overall process, including the BNs and surveys, constitutes a generalisable structured workflow for selecting the most promising strategies. We describe the model development and validation, and the broader applicability of our BN-based workflow in implementation science. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The project was funded through a National Health and Medical Research Council Partnership Grant GTN1170735 and a Medical Research Future Fund Investigator Grant MRF1193796. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics approval for our study was obtained from the Child and Adolescent Health Service Ethics Committee (RGS 4136), Western Australian Aboriginal Health Ethics Committee (HREC 774), Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (HREC 2021-3954), and reciprocal ethics was given by the University of Queensland Human Research Ethics Committee (2020002563). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Anonymised survey response data can be made available upon reasonable request to the authors.

Culturally safe healthcare approaches are important to improve outcomes of Indigenous people. Non-Indigenous clinicians are often ill-prepared to provide such healthcare. The NHMRC Centre for Research Excellence (CRE) especially for First Nations Children has been studying for several years how to improve clinical care for Indigenous children with respiratory disease in hospital, clinic, urban, rural and remote settings. At a CRE meeting in 2023 key themes were identified based on what we have learned. Themes were informed by research conducted by the CRE and supplemented by relevant manuscripts known to CRE members. This manuscript provides practical information to aid clinicians in providing culturally safe healthcare to Indigenous people. In brief, the provision of health information that is relevant and understandable to Indigenous patients and their families is critical for ensuring condition-specific health literacy and to allow Indigenous patients to gain autonomy over medical care provided to them and their children. Methods to facilitate effective communication between healthcare providers and patients, and the creation of a culturally safe healthcare environments are discussed. The manuscript will be of practical use to clinicians and translatable to other areas of health care.

Purpose Limited data exists on the relationship between sociodemographic and cultural variables and the prevalence of specific mental and substance use disorders (MSDs) among Indigenous Australians, using diagnostic prevalence data. This paper utilises data from the Queensland Urban Indigenous Mental Health Survey (QUIMHS), a population-level diagnostic mental health survey, to identify socioeconomic and cultural correlates of psychological distress and specific MSDs in an urban Indigenous Australian sample. Methods Using a mixture of household sampling (door-knocking) and snowball sampling (promotion of the survey in the community), 406 participants aged 18 to 89 were recruited across key locations in Southeast Queensland. The study investigated various demographic, socioeconomic, and cultural factors as predictors of psychological distress (measured by the Kessler-5) and MSD diagnoses (utilising the Composite International Diagnostic Interview, CIDI 3.0) using a series of univariate logistic regressions. Results Individuals in unstable housing (homeless, sleeping rough) and those reporting financial distress were more likely to experience an MSD in the past 12 months and throughout their lifetime. Individuals reporting lower levels of connection and belonging, limited participation in cultural events, and lower empowerment were more likely to have a lifetime mental disorder. Conclusion This data emphasises the importance of addressing systemic and social determinants of health when designing and delivering community mental health services and underscores the need for holistic approaches when working with Indigenous communities.

Purpose National and global resistance opposes the criminalisation and punitive punishment of Aboriginal and Torres Strait Islander children with complex needs, including harmful incarceration practices of children as young as 10 years of age. The aim of this scoping review is to understand the available evidence regarding culturally responsive diversion programs for Aboriginal and Torres Strait Islander children. Methods Six databases were searched (PuBMed, Informit, Embase, CINAHL, Web of Science and PsycINFO). Further evidence was retrieved from Google Scholar and state and territory youth justice websites. Studies met criteria if they were from Australia, were diversion programs and included Aboriginal and Torres Strait Islander children aged between 10 to 18 years of age. The cultural responsiveness of the included diversion programs was synthesised by applying a decolonised and Indigenist Social and Emotional Wellbeing (SEWB) Framework. Studies were assessed according to seven domains of the SEWB Framework. Main findings Thirty-one studies met inclusion criteria. Fifteen types of diversion programs were identified, and they varied widely in their cultural responsiveness. Ten studies were scored in the high range, 16 studies were scored in the medium range and five studies were scored in the low range in cultural responsiveness. Principal conclusions A range of different types of diversionary programs were evaluated. Culturally responsive programs were Indigenous-led, placed based, holistic, life-course, and healing and family centred.

ABSTRACTBackgroundThis systematic review aims to highlight the scope of pharmacogenomics research within global Indigenous populations. This review also explores the barriers and facilitators of pharmacogenomics research within this population.MethodologyA systematic review of literature was conducted to identify and present an understanding of current empirical evidence demonstrating the conduct of genomics or pharmacogenomics research within global Indigenous populations (PROSPERO registration: CRD42021257226). Using key search terms, relevant databases were searched for articles published between January 2010 and July 2022. Screening, data extraction, and analysis was conducted using well‐defined inclusion criteria. Quality assessment and risk of bias appraisal was conducted using the mixed methods appraisal tool. Indigenous community engagement and participation in genomics research was assessed using the social‐ecological framework.ResultsFrom the 427 articles identified, 77 articles met inclusion criteria and underwent full‐text screening. Of these, 30 articles were included in the final review, with 16 being quantitative and 14 either qualitative or mixed methods studies. Most studies were conducted with native Indigenous populations from the United States of America (36%). Content analysis revealed that studies either explored genetic variations associated with disease in Indigenous populations (23%) or markers for drug metabolism (30%) or were designed to understand perspectives of genomics research within this population (47%). Perspectives included the exploration of the role of participants in research, benefits or outcomes achieved from participation in genomics research, and levels of Indigenous engagement and participation in genomics research.ConclusionsThis review highlights a growing gap in Indigenous genomics research globally. It presents several important considerations from Indigenous participants, identifying how researchers can co‐create culturally safe and inclusive design, implementation, analysis, and subsequent outcomes of genomics research involving Indigenous people. Indigenous governance, self‐determination and leadership is essential, with researchers required to be responsive to such fundamental partnerships for research to progress.