IntroductionOur study aimed to identify factors that influence access to eye care and eye health outcomes for remote Indigenous Australians living with diabetes.MethodsIn collaboration with Indigenous Community-Based Researchers (CBR) and Aboriginal Community Controlled Health Services (ACCHS), a qualitative, participatory action research approach was taken, drawing on Indigenist and decolonising methodologies. The study was undertaken in four remote communities, in the Katherine region, Northern Territory and north-western New South Wales, Australia. Interviews and focus groups were undertaken with Indigenous adults aged ≥40 years living with diabetes (n=110), and primary care clinicians working in ACCHSs (n=37). A series of interviews with CBRs (n=13) were undertaken before and after data collection to add cultural insights and validation to participant accounts. Data were analysed inductively using grounded theory, in-depth discussion and NVivo V.11.ResultsMore than one-third of all patients had little to no knowledge of how diabetes affects eye health. Limited access to health information and interpreters, language barriers, distrust of health providers and services, and limited cultural responsivity among non-Indigenous clinicians, were identified as determining factors in eye health and care.DiscussionWe outline a need to address gaps in trust and communication, through increased access to and resourcing of Indigenous language interpreters and cultural brokers, understandable and culturally sensitive diabetic eye health information and cultural responsivity training for non-Indigenous clinicians. Centring Indigenous cultures in healthcare practice will enable a shared understanding between clinicians and Indigenous patients, and subsequently more equitable eye health outcomes.

Many programmes formally engage Australian Indigenous people in land and sea management to provide environmental services. There are also many Indigenous people who 'look after country' without rewards or payment because of cultural obligations. We investigated how Indigenous peoples' mobility in and around two communities (Maningrida and Ngukurr) is affected by their formal or informal engagement in cultural and natural resource management (CNRM). Understanding factors that influence peoples' mobility is important if essential services are to be provided to communities efficiently. We found that those providing formal CNRM were significantly less likely to stay away from settlements than among those 'looking after their country' without payment or reward. Paying Indigenous people to engage with markets for CNRM through carbon farming or payments for environmental services (PES) schemes may alter traditional activities and reduce mobility, particularly movements away from communities that extend the time spent overnight on country. This could have both environmental and social consequences that could be managed through greater opportunities for people to engage in formal CNRM while living away from communities and greater recognition of the centrality of culture to all Indigenous CNRM, formal or otherwise. Keywords: cultural obligations; fire management; land and sea management; 'looking after country'; payments for environmental services (PES); pest control; temporary movements healthy people? Exploring the health benefits of Indigenous natural resource management.