Culturally appropriate methodology in obtaining a representative sample of South Australian Aboriginal adults for a cross-sectional population health study: challenges and resolutions

Abstract

BackgroundThe considerably lower average life expectancy of Aboriginal and Torres Strait Islander Australians, compared with non-Aboriginal and non-Torres Strait Islander Australians, has been widely reported. Prevalence data for chronic disease and health risk factors are needed to provide evidence based estimates for Australian Aboriginal and Torres Strait Islanders population health planning. Representative surveys for these populations are difficult due to complex methodology. The focus of this paper is to describe in detail the methodological challenges and resolutions of a representative South Australian Aboriginal population-based health survey.MethodsUsing a stratified multi-stage sampling methodology based on the Australian Bureau of Statistics 2006 Census with culturally appropriate and epidemiological rigorous methods, 11,428 randomly selected dwellings were approached from a total of 209 census collection districts. All persons eligible for the survey identified as Aboriginal and/or Torres Strait Islander and were selected from dwellings identified as having one or more Aboriginal person(s) living there at the time of the survey.ResultsOverall, the 399 interviews from an eligible sample of 691 SA Aboriginal adults yielded a response rate of 57.7%. These face-to-face interviews were conducted by ten interviewers retained from a total of 27 trained Aboriginal interviewers. Challenges were found in three main areas: identification and recruitment of participants; interviewer recruitment and retainment; and using appropriate engagement with communities. These challenges were resolved, or at least mainly overcome, by following local protocols with communities and their representatives, and reaching agreement on the process of research for Aboriginal people.ConclusionsObtaining a representative sample of Aboriginal participants in a culturally appropriate way was methodologically challenging and required high levels of commitment and resources. Adhering to these principles has resulted in a rich and unique data set that provides an overview of the self-reported health status for Aboriginal people living in South Australia. This process provides some important principles to be followed when engaging with Aboriginal people and their communities for the purpose of health research.

Common mental disorders among Indigenous people living in regional, remote and metropolitan Australia: a cross-sectional study

“…Laycock et al 28 have articulated the guiding principles of research in Indigenous Australians spirit and integrity; reciprocity; respect; equality; survival and protection; and responsibility. The barriers and enablers of randomised sampling and recruitment in larger Indigenous epidemiological studies have been documented by Fox et al 29 and Marin et al 30 A prerequisite is meaningful and respectful engagement with Indigenous communities using community-specific approaches. Individuals in such communities volunteer to participate and do not appreciate the Western concept of being randomised ‘in’ or ‘out’ of the study, the latter being considered disrespectful.…”

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“…Our finding that almost half of the Aboriginal invitees to the follow-up study participated in the postal survey is encouraging and provides evidence to show that postal surveys can be used to undertake follow-up studies among Aboriginal people. A study, recently published by Marin and colleagues, on obtaining a representative sample for the South Australian Aboriginal population-based health survey [ 28 ] reported a 57.7 % response rate; that study used a variety of recruitment strategies and face-to-face interviews for data collection. Reasons for non-participation included: refusals (19.4 %), unavailable for interview (19.5 %), illness/incapability to undertake interview or having moved house since first contact (3.3 %).…”

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“…There is no established definition of a satisfactory retention rate, but previous studies of Aboriginal and Torres Strait Islander peoples have described retention rates between 45 and 85% as satisfactory [ 12 , 16 , 19 , 25 ]. The retention achieved in Footprints in Time (70.4% at Wave 6) matches that of longitudinal studies of the total Australian population conducted by Department of Social Services.…”

“…The Longitudinal Study of Australian children maintained 72.4% of the baseline sample at the 6th wave of follow-up ( n = 7301/10,090); the study of Household, Income and Labour Dynamics in Australia maintained 72.2% of the baseline sample at the 6th wave of follow up ( n = 12,905/13,969) [ 50 ]. The ability of Footprints in Time to maintain an equivalent response rate despite additional complexities (including high mobility and respondent burden, and negative research experiences [ 12 , 16 , 19 , 51 , 52 ]) suggests effective study methodology and implementation.…”