MNP6101 Aboriginal And Torres Strait Islander Peoples

The Aboriginal and Torres Strait Islander peoples are considered a vulnerable population when conducting research because of numerous factors affecting their health and overall wellbeing (Arney & Scott, 2013. p. 124). Some of the factors of vulnerability include historical, social, clinical, and cultural factors.

Historical factors

The historical factors of vulnerability trace their roots back to the colonial times by the British government. The British colonial system did not value, understand, or respect the Indigenous Australians. According to Lindstedt, Moeller-Saxone, Black, Herrman and  Szwarc (2017) the effects of the colonial injustices such as forceful removal from their native lands, seizure of their lands that led to violence, denial of their rights to maintain their culture and language when they were moved to reserves, denial of self-determination, physical and sexual abuse, and forceful removal from their families and communities were devastating. The effects of the historical injustices led to high incidences of trauma. Traumatization led to high rates of mental health issues, addiction, imprisonments, domestic squabbles, personal injuries, and suicide (Lindstedt, Moeller-Saxone, Black, Herrman & Szwarc, 2017. p.3).

The Indigenous Australians continue to experience these detrimental effects of historical injustices and discrimination today. Lindstedt et al. (2017) explains that the existing communities are still affected by the legacy left behind by the older generation. Therefore, when conducting research, it is necessary that the Aboriginal and Torres Strait Islander people are viewed in the context of historical factors which are a contributing factor to their vulnerability in the society.

Social factors

Since the time of colonization, the Aboriginal and Torres Strait Islander people have been marginalized. They were socially excluded and were denied the rights and privileges of the mainstream social system by being denied the chance to participate in the social system. Social exclusion ranges from racism, refusal to form friendships, bullying, and non-recognition. Calma, Dudgeon and Bray (2017) explains that over the generations, the indigenous people have been deprived of education, healthcare, and employment because of their race.

Currently, the Aboriginal and Torres Strait Islander people continue to be the most secluded and discriminated group in the whole of Australia. The effects of the social exclusion are evident and are reflected in cases such as high rates of unemployment, incarceration, poor health, poverty, homelessness, politics, and lack of education (Calma, Dudgeon & Bray, 2017. p. 62). The past experiences of prejudice and discrimination has led to extensive anger, mistrust, and resentment among the people of the Aboriginal and Torres Strait Islander towards the government authorities.

Clinical factors

Improving the status of health of the Aboriginal and Torres Strait Islander people has been a great task in the Australian government.  Some improvements have been noted although the progress has been slow and unreliable. There exists an apparent gap between the Aboriginal and Torres Strait Islanders and the other Australians which remains real. The inequality gap has not been reduced progressively and it is very wide. The Indigenous people have poor health and the health inequalities that exist are especially with reference to infant health, mental health, life expectancy, and communicable and chronic diseases (Gibson-Helm et al., 2018. p.2). Many factors have led to the poor health of the Aboriginal and Torres Islander peoples. Some of these factors include low levels of health knowledge, lack of means of transport to access health care services, lack of affordability and availability of healthcare facilities, institutional racism, and cultural relevance of health services.

A research conducted by Bradley, Dunn, Lowell and Nagel (2015) showed that the Indigenous people are often discriminated because of their race in health facilities whereby they feel unwelcome, uncomfortable, and prejudged. Other social inequalities such as their daily life are also a contributing factor to the gap inequality. The poor health status and the health inequalities such as discrimination as witnessed among the Aboriginal and Torres Strait Islander groups have resulted to their vulnerability.

Cultural factors

Colonization by the British government attacked certain values that changed the lifestyle and the culture of the Torres Strait Islanders by specifically targeting the roles of men in their families. These values included spirituality, identity, relationships, and responsibilities (Best & Fredericks, 2017. p. 103). By removing men and women from their families and changing their names led to a loss of identity. Any other identity in relation to their roles in the larger community was also lost since they were placed in secluded islands, institutions, and missions away from their homes. Men were protectors of their families and were responsible for food, security, affection, and safety but these responsibilities were forcefully removed from them. Family responsibilities were shifted to the national government who determined when and to whom resources were given.

Best and Fredericks (2017) explains that broken relationships deprived parents their rights to be parents and to nurture their children. Many men grew up without the knowledge of showing affection and emotions to build solid relationships within their own families and other men. The spirituality of the Aboriginal and Torres Strait Islander peoples was replaced by an imposed religion which did not depict their previous religion. The Aboriginal spirituality provided a sense of continuity and how to live in harmony. Due to the loss of culture, the Indigenous people have suffered and struggled with their loss of identity since it is culture that describes the identity of an individual. Additionally, the loss of culture has led to a complicated relationship with the mainstream Australia due to their participation in the deterioration of the Aboriginal culture.

Ethical guidelines and principles

Kozier et al. (2014) states that the Indigenous Australians have several rights, which includes rights of self-governance, just and unhindered participation in research or activities that affect them, preservation and regulation of their heritage and culture. With reference to these rights, guidelines and principles have been put in place to protect this vulnerable population when conducting a research. There are 14 guidelines that have been grouped under six broader categories. Gerrig, Zimbardo & Campbell (2015) explains that these six broader categories include; i) Right, honour, and acknowledgement, ii) Cooperation, consensus, and mutual understanding, iii) Involvement and partnership, iv) Gains, results, and corporate social responsibility, v) Research management- data usage, storage, and retrieval, vi) Reporting and conformation.

Right, honour, and acknowledgement

Principle 1

Recognizing the individuality and diversity of people is vital.

The diversity of the Indigenous Australians including the differences in their perceptions and cultures must be recognized by the research.

Principle 2

Israel (2015) continues to state that recognition of the rights of self-governance of Indigenous peoples must be considered.

Research studies should be carried out in conformity to the ‘United Nations Declaration on the Rights of Indigenous Peoples’.

Principle 3

Farnbach et al. (2017) explains that acknowledgement of the intangible tradition of Indigenous peoples must be considered.

The research studies must be done in a manner that maintains, control, develop, and protect their tangible heritage including culture, traditional knowledge, intellectual property, and expressions of their traditional culture.

Principle 4

Israel (2015) discusses that traditional knowledge and cultural prospects of Indigenous people must be honoured, guarded, and preserved.

Researchers must be aware of the Indigenous traditional expressions, intellectual property and systems of knowledge in order to defend, respect, and uphold their rights.

Principle 5

 Indigenous knowledge, way of life, and inventions, must be guarded, respected, and preserved (Israel, 2015. p.54).

Respecting and acknowledging the innovations and the practices of the Indigenous peoples is a recognition that the knowledge may contribute significantly in the process of research (Farnbach, Eades, Gwynn, Glozier & Hackett, 2018. p. 9).

Cooperation, consensus, and mutual understanding 

Principle 6

Discussion, cooperation, and free prior and knowledgeable consent are the basics for research about Indigenous peoples (Israel, 2015. p.54).

 Informed consent that is free is whereby agreement is obtained without pressure and to ensure that the participants are completely cognizant of the risks and details of the study (Ary, Jacobs, Sorensen & Walker, 2018. p. 406).

Principle 7

According to Farnbach et al. (2017) there should be accountability for an ongoing discussion and negotiation.

Consultation safeguards prior and free informed consent of the research study and preserves the consent. The community participating should be allowed to continued opportunities to consider the research.

Principle 8

There should be common understanding which is achieved by negotiation and discussions about the study (Israel, 2015. p.54).

Indigenous communities should be given an honest communication about the methods, aims, and possible outcomes for both parties. Being properly informed about the research enables the Indigenous people to decide on either opposing or embracing the project.

Principle 9

Farnbach et al. (2017) discusses that negotiation should end in an official agreement about conducting a research study.

In order to safeguard the community and the investigator, a written agreement should be the end result of negotiation and consultation.

Involvement and partnership 

Principle 10

Indigenous Australians should fully participate in studies and processes that are suitable to their experiences and skills.

Indigenous perceptions should be merged in the research on indigenous issues which may be achieved by the facilitation of the participation in the study from the beginning of the research.

Gains, results, and corporate social responsibility 

Principle 11

Indigenous participants or those who may be affected by the research, should gain from the research study (Farnbach et al., 2017. p.9).

Indigenous people who participate in the research should receive equal and fair benefits for contributing traditional knowledge, skills, and cultural products and expressions.

Principle 12

Israel (2015) discusses that research results should contain explicit results that responds to the desires and welfares of the Indigenous people.

Research results should respond to the welfare of the Aboriginals. Both the needs of participants and the community affected should be responded to (Farnbach et al., 2017. p.9).

Research management- data usage, storage, and retrieval 

Principle 13

According to Farnbach et al. (2017) there should be agreed plans of data usage, storage, and retrieval.

The expectations of the community, the outcomes, and accessibility of the results should be agreed and documented.

Reporting and compliance

Principle 14

Suitable mechanisms and measures for reporting on ethical issues of study and compliance with the guidelines should be included in research studies.

Bodies that fund reseach and the researchers need to ensure that suitable ongoing processes are available for reporting the progress in research particularly regarding any potential or actual changes with regards to the ethical context.

Critical Appraisal of Journal Article

 Heydari, Vafaei and Bakhshi (2017) explains that critical appraisal of research studies is an important aspect of evidenced-based nursing practice that enables the reader to assess the validity of the study by appraising the strengths and weaknesses.

In this section of the paper, I applied the Critical Appraisal Skills Program (CASP) tool to critical appraise the provided research paper (Mills & Birks, 2014. p.230). The completed CASP tool is included as an appendix.

Below, I have discussed and critiqued the strengths and weaknesses of the study in relation to the study aims, the methodology, recruitment, data collection, data analysis, ethical consideration, potential bias, findings, and the clinical significance of the study.

Study Aims

According to the discussion on aims of research by Harder (2014) the research study aims were clear. The aim was to understand the experience, understanding, and impact of menopause among the Australia’s Aboriginal women. The importance of the study which was to secure healthcare for the women was equally discussed comprehensively (Braun & Clarke, 2014.p.4). The researches discussed that the Aboriginal women have a higher prevalence of the health risk factors which may be a contributing factor to their experience of menopause. Additionally, the researchers noted that the study was relevant because the Aboriginal women are a disadvantaged community because of their average onset of menopause which is five years less compared to that of the non-Aboriginal women.

Methodology/study design

The qualitative methodology of the research design was very appropriate for this study. As discussed by Greenhalgh (2014), quantitative study is aimed at interpreting the actions and the subjective experiences of the research participants. In this research, the participants were asked to explain their experiences and understanding of menopause. Inasmuch as the researcher used the appropriate study design in conducting the research, justification of the research design and methodology was not discussed. The researcher did not explain why they decided to use the interviews and the group discussion methods to carry out the research. However, due to the fact that the aims of the study were to understand the experiences and understanding of menopause of the Aboriginal women, qualitative research was the right design to address the goals (Greenhalgh, 2014. p.46).

 Recruitment

It is not possible to tell whether the strategy for recruitment was suitable to the aims of the research or not. Although the researcher explained the participants mode of selection, there were no discussions related to recruitment such as to why some women chose not to take part. The researcher only explains the inclusion criteria which explained why those particular participants chosen were the most appropriate to provide the kind of information required by the research study. There was an inconsistency in the kind of participants recruited for the study. The discussion on the participants stated that all the 25 participants were women of the Aboriginal origin. However, in the results section, the researcher stated that there was one interview with three participants and two of the participants in the same interview were non-Indigenous. Holly, Salmond and Saimbert (2016) discusses that inconsistency compromises the validity of study hence the inconsistency above may comprise the results of the research.

Data collection

The data collection was addressed in a manner that discourses the study aims. The setting of the data collection was justified whereby the researchers used the consulting room for Geraldton Regional Aboriginal Medical Service (GRAMS) which was private enough. The hospital setting was also appropriate since the women would be approached while at the waiting area of the hospital. The research also indicates clearly how the data was collected through the interviews and the focus groups although justification of the methods of data collection was not discussed. The interviews were very explicit and the researcher has indicated how the semi -structured interviews were conducted using questions. The form of data collection was clear by audio-taping the interviews with the consent of the participant and transcribing in full (Yeong, 2014. p. 2). Burns, Gray and Grove (2015) discusses that data must be saturated for data collection to stop. The study indicates that the interviews were allowed to continue until the saturation of data where there was negligible new data being obtained. 

Data Analysis

The data analysis of the research study was satisfactorily rigorous whereby in-depth explanation of the data analysis was done. Thematic analysis was done and it was clear how the themes were derived from the data. Transcription was read line-by-line, identification and significant themes were highlighted, and the occurrence and circulation was done. Consequently, sub themes which were derived from the key themes were added. Since the interviews were done to saturation, adequate data was presented to substantiate the findings. Contradictory of data was searched to ensure trustworthiness of the data and connecting the findings and deductions to data, literature, and theory. The transcripts were not individually checked by all the researches during the data analysis. This could pose a potential bias by the researcher on certain transcripts hence the validity of the data analysis is questionable.

Ethical consideration

Inasmuch as there was an approval from the University of Western Australia Human Research Ethic Office and the Western Australian Aboriginal Health Information and Ethics Committee (WAAHEC), there is no further information or details showing how the research was clarified to the research participants. The absence of how the specifics of the research was explained to the participants does not allow the reader to evaluate whether ethical standards were upheld during the research. The researcher highlights that the study was based on informed consent although there is no discussion on the issues surrounding the consent or privacy such as how the study consequences were handled throughout and after the study . Failure to discuss the details of the research to the Aboriginal women could lead to serious legal complications and could warrant this study invalid (Maltby, Williams, McGarry & Day, 2014. p.255).

Potential Bias

The researcher noted some potential biases in the study. During the study, the interviews were conducted by two non-Aboriginal women which may have been a source of barrier for the research participants disclosing more details about their experiences. The women would have provided more details if women of the Aboriginal origin had conducted the interviews. Additionally, there was no systematic way of checking each transcript by each member which could have contributed to a potential bias in the data analysis (Fortune, Reid & Miller, 2013. p.25).

Findings

The findings were very explicit and each theme was explained adequately. The researcher discussed every theme and provided evidence that were both for and against the arguments of the researcher. Credibility of the findings were discussed whereby there was more than one analyst. The researcher states that the discussion was done within the team members of the research. The presentations of the results and the discussions took place at GRAMS and at the local women health centre. The presentation into the two health centres guaranteed a larger input into the interpretation, trustworthiness, and validity of the findings. The researcher discussed the findings with respect to the Aboriginal women experiences and understanding of menopause. It can be therefore concluded that following the above discussions, the findings were valid (Haber, 2014.p.103).

Clinical significance and application of the study results

In conclusion, this study contributes to the existing knowledge of the need to develop relevant menopause study materials for the Aboriginal women and the Aboriginal health staffs. Additionally, the study has identified new areas of future research. The findings of the research show a connection between the social and physical changes related to menopause which would be a possible preliminary point on the future research on the concept of ‘status passages’. However, the findings of this study may not be transferred to other populations since the participants were recruited from just a specific geographical area. There was no diversity of participants from different regions which may have provided a great variety of information (Hays, Hayes, Oermann & Hays, 2015. p. 13).

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