Structural modelling of wellbeing for Indigenous Australians: importance of mental health

Abstract

Background Australia provides health care services for Indigenous peoples as part of its effort to enhance Indigenous peoples’ wellbeing. However, biomedical frameworks shape Australia’s health care system, often without reference to Indigenous wellbeing priorities. Under Indigenous leadership the Interplay research project explored wellbeing for Indigenous Australians in remote regions, through defining and quantifying Indigenous people’s values and priorities. This article aimed to quantify relationships between health care access, mental and physical health, and wellbeing to guide services to enhance wellbeing for Indigenous Australians in remote regions. Methods Indigenous and non-Indigenous researchers worked with Indigenous people in remote Australia to create a framework of wellbeing priorities. Indigenous community priorities were community, culture and empowerment; these interplay with government priorities for Indigenous development of health, education and employment. The wellbeing framework was further explored in four Indigenous communities through a survey which measured aspects of the wellbeing priorities. Indigenous community researchers administered the survey in their home communities to 841 Indigenous people aged 15 to 34 years from June 2014. From the survey items, exploratory factor analysis was used to develop constructs for mental and physical health, barriers to health care access and wellbeing. Relationships between these constructs were quantified through structural equation modelling. Results Participants reported high levels of health and physical health (mean scores (3.17/4 [SD 0.96]; and 3.76/4 [SD 0.73]) and wellbeing 8.07/10 [SD 1.94]. Transport and costs comprised the construct for barriers to health care access (mean access score 0.89/1 [SD 0.28]). Structural equation modelling showed that mental health, but not physical health was associated with wellbeing (β = 0.25, P < 0.001; β = − 0.038, P = 0.3). Health care access had an indirect positive relationship with wellbeing through mental health (β = 0.047, P = 0.007). Relationships differed significantly for participants in remote compared with those in very remote communities. Conclusions Greater attention to mental health and recognition of the role of services outside the health care sector may have positive impacts on wellbeing for Indigenous people in remote/ very remote Australia. Aggregation of remote and very remote populations may obscure important differences between Indigenous communities.

Screening for diabetic retinopathy and reduced vision among Indigenous Australians in Top End primary care health services: a TEAMSnet sub‐study

“…Schultz et al . emphasised that concentrating on mental health and the role of services outside the health sector may positively impact well‐being of indigenous people in remote/very remote Australia 24 . More attention to overall worker well‐being may empower workers, improve work morale and reduce high staff turnover rates 24 .…”

“…emphasised that concentrating on mental health and the role of services outside the health sector may positively impact well‐being of indigenous people in remote/very remote Australia 24 . More attention to overall worker well‐being may empower workers, improve work morale and reduce high staff turnover rates 24 . Well implemented resources to improve the overall well‐being of the indigenous population, including community needs, may directly benefit overall health.…”

Co-Designing Health Service Evaluation Tools That Foreground First Nation Worldviews for Better Mental Health and Wellbeing Outcomes

“…Aboriginal and Torres Strait Islander people have a different worldview about mental health and wellbeing as compared to non-Indigenous people. Their experiences are predicated on the impact of colonisation and intrinsically linked to kin, culture and Country [15][16][17][18][19][20]. However, mainstream mental health services are predominantly structured in western ways that do not easily respond to the lived experiences of Aboriginal and Torres Strait Islander people seeking support for mental health concerns [21,22].…”

“…Finally, the design of the survey to capture multiple perspectives of a client's service experience acknowledges the critical role of family and community in understanding and integrating collective experiences of wellbeing and recovery [15,16,[50][51][52][55][56][57][58][64][65][66]. This exemplifies the role relationships play in people's lived experience being shared, connected, and central to a person's sense of belonging and wellness.…”

“…This exemplifies the role relationships play in people's lived experience being shared, connected, and central to a person's sense of belonging and wellness. Coupled with more strengths-based discourse, these connections enable Aboriginal communities to see improvement and progress amidst the ongoing concerns about their social and emotional wellbeing [15][16][17][18][19][21][22][23][24][25][26].…”