BackgroundThe burden of chronic disease in Indigenous Australia is more than double that of non-Indigenous populations and even higher in remote Northern Territory (NT) communities. Sufficient levels of physical activity are known to reduce the risk of chronic disease and improve the health of those already suffering from chronic disease. It has been identified that effective promotion of physical activity in Indigenous settings requires the diverse cultural perspectives and participation of Indigenous people. However, Indigenous concepts of physical activity are not represented in the public health literature and examples of Indigenous involvement in physical activity promotion are scarce. This study aimed to explore and describe local perspectives, experiences and meanings of physical activity in two remote NT Indigenous communities.MethodsQualitative research methods guided by ethnographic and participatory action research principles were used. Semi-structured interviews conducted with 23 purposively selected community members were the main source of data, augmented by five commissioned paintings by community-based artists and observations recorded in a journal by the first author.ResultsThe findings reveal that in this cultural context the meaning of physical activity is embedded in socially significant and economically necessary physical engagement with the environment. Participants described physical activities associated with Indigenous natural and cultural resource management, customary spaces, seasonal timing and traditional education as creating and protecting health. These activities were viewed not only as culturally appropriate physical activities that contribute to health but as legitimate, physically active forms of social organisation, education and employment that help to build and maintain relationships, wealth, resources and the environment.ConclusionThis different construction of physical activity in remote Indigenous communities highlights the importance of involving Indigenous people in the development and implementation of physical activity promotion. Physical activities associated with traditional Indigenous cultural practices and being active ‘on country’ need to be viewed as legitimate health promotion activities. Exploring further ways to enable Indigenous people in remote NT to be involved in creating viable active livelihoods on ‘traditional country’ needs to be considered as imperative to health improvement.

BackgroundPrevious research suggests that Internet-based cognitive behavioral therapy (ICBT) has a positive effect on symptoms of depression. ICBT appears to be more effective with therapist support, but it is unclear what this support should comprise. General practitioners (GPs) have positive attitudes toward ICBT. However, ICBT is rarely used in regular care in general practice. More research is warranted to integrate the potential of ICBT as part of regular care.ObjectiveThe aim of this study was to explore aspects perceived by GPs to affect the implementation of guided ICBT in daily practice. Understanding their perspectives may contribute to improving the treatment of depression in the context of general practice.MethodsA training package (3-day course) introducing a Norwegian translation of the ICBT program MoodGYM was developed and presented to GPs in Norway. Following training, GPs were asked to include guided ICBT in their regular care of patients with symptoms of depression by providing brief, face-to-face follow-up consultations between modules. We interviewed 11 GPs who had taken the course. Our interview guide comprised open questions that encouraged GPs to frame their responses using examples from their experiences when implementing ICBT. Thematic analysis was chosen to explore patterns across the data.ResultsAn overall belief that ICBT would benefit both the patients’ health and the GPs’ own work satisfaction prompted the GPs to take the ICBT course. ICBT motivated them to invest time and effort in improving treatment. The most important motivating aspects in MoodGYM were that a program based on cognitive behavioral therapy could add a structured agenda to their consultations and empower depressed patients. Organizational aspects, such as a lack of time and varied practice, inhibited the use of ICBT. Inadequate knowledge, recalling the program, and changing own habits were also challenging. The GPs were ambivalent about whether ICBT had a negative impact on the doctor–patient interaction in the module follow-ups. Generally, GPs made an effort to recommend MoodGYM, but the expected module follow-ups were often not provided to patients and instead the GPs returned to standard treatment.ConclusionsGPs’ feedback in the present study contribute to our understanding of the challenges of changing treatment for depression. Our findings indicated that recommending ICBT could add to the GP’s toolkit. Offering training and highlighting the following aspects may increase recommendation of ICBT by GPs: (1) ICBT is theory-based and credible, (2) ICBT increases the GPs’ work satisfaction by having a tool to offer, and (3) ICBT facilitates empowerment of patients in their own health. In addition, the present study also indicated that complex aspects must be accommodated before module follow-ups can be incorporated into GPs’ treatment of depression.

BackgroundWe report here selected findings from a mixed-methods study investigating the role of Australian rare disease patient organisations (RDPOs) in research. Despite there being many examples of RDPOs that have initiated and supported significant scientific advances, there is little information – and none at all in Australia – about RDPOs generally, and their research-related goals, activities, and experiences. This information is a pre-requisite for understanding what RDPOs bring to research and how their involvement could be strengthened.MethodsWe reviewed 112 RDPO websites, conducted an online survey completed by 61 organisational leaders, and interviewed ten leaders and two key informants. Quantitative and qualitative data were analysed using basic descriptive statistics and content analysis, respectively.ResultsAlthough most are small volunteer-based groups, more than 90 % of the surveyed RDPOs had a goal to promote or support research on the diseases affecting their members. Nearly all (95 %) had undertaken at least one research-related activity – such as providing funding or other support to researchers – in the previous five years. However, RDPO leaders reported considerable challenges in meeting their research goals. Difficulties most frequently identified were insufficient RDPO resources, and a perceived lack of researchers interested in studying their diseases. Other concerns included inadequate RDPO expertise in governing research “investments”, and difficulty engaging researchers in the organisation’s knowledge and ideas. We discuss these perceived challenges in the light of two systemic issues: the proliferation of and lack of collaboration between RDPOs, and the lack of specific governmental policies and resources supporting rare disease research and patient advocacy in Australia.ConclusionThis study provides unique information about the experiences of RDPOs generally, rather than experiences retrospectively reported by RDPOs associated with successful research. We describe RDPOs’ valuable contributions to research, while also providing insights into the difficulties for small organisations trying to promote research. The study is relevant internationally because of what it tells us about RDPOs; however, we draw attention to specific opportunities in Australia to support RDPOs’ involvement in research, for the benefit of current and future generations affected by rare diseases.