ORCID Profile
0000-0002-2758-6473
Current Organisations
University of California, San Diego
,
Charles Darwin University
,
Menzies School of Health Research
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Publisher: Wiley
Date: 02-2018
DOI: 10.1111/NEP.13233
Publisher: Springer Science and Business Media LLC
Date: 04-06-2021
DOI: 10.1186/S12913-021-06564-4
Abstract: Globally, interpreters are underused by health providers in hospitals, despite 40 years of evidence documenting benefits to both patients and providers. At Royal Darwin Hospital, in Australia’s Northern Territory, 60-90% of patients are Aboriginal, and 60% speak an Aboriginal language, but only approximately 17% access an interpreter. Recognising this system failure, the NT Aboriginal Interpreter Service and Royal Darwin Hospital piloted a new model with interpreters embedded in a renal team during medical ward rounds for 4 weeks in 2019. This research was embedded in a larger Participatory Action Research study examining cultural safety and communication at Royal Darwin Hospital. Six Aboriginal language speaking patients (five Yolŋu and one Tiwi), three non-Indigenous doctors and five Aboriginal interpreter staff were purposefully s led. Data sources included participant interviews conducted in either the patient’s language or English, researcher field notes from shadowing doctors, doctors’ reflective journals, interpreter job logs and patient language lists. Inductive narrative analysis, guided by critical theory and Aboriginal knowledges, was conducted. The hospital experience of Yolŋu and Tiwi participants was transformed through consistent access to interpreters who enabled patients to express their clinical and non-clinical needs. Aboriginal language-speaking patients experienced a transformation to culturally safe care. After initially reporting feeling “stuck” and disempowered when forced to communicate in English, participants reported feeling satisfied with their care and empowered by consistent access to the trusted interpreters, who shared their culture and worldviews. Interpreters also enabled providers to listen to concerns and priorities expressed by patients, which resulted in holistic care to address social determinants of health. This improved patient trajectories and reduced self-discharge rates. A culturally unsafe system which restricted people’s ability to receive equitable healthcare in their first language was overturned by embedding interpreters in a renal medical team. This research is the first to demonstrate the importance of consistent interpreter use for providing culturally safe care for Aboriginal patients in Australia.
Publisher: Springer Science and Business Media LLC
Date: 04-08-2023
DOI: 10.1057/S41599-023-01965-8
Abstract: The COVID-19 pandemic, coupled with the “infodemic” of misinformation, meant First Nations peoples in Australia’s Northern Territory were hearing “the wrong story” about COVID-19 vaccines. In March 2021, when the Australian government offered COVID-19 vaccines to First Nations adults there was no vaccine information designed with, or for, the priority group. To address this gap, we conducted a Participatory Action Research project in which First Nations leaders collaborated with White clinicians, communication researchers and practitioners to co-design 16 COVID-19 vaccine videos presented by First Nations leaders who spoke 9 languages. Our approach was guided by Critical Race Theory and decolonising processes including Freirean pedagogy. Data included interviews and social media analytics. Videos, mainly distributed by Facebook, were valued by the target audience because trusted leaders delivered information in a culturally safe manner and the message did not attempt to enforce vaccination but instead provided information to sovereign in iduals to make an informed choice. The co-design production process was found to be as important as the video outputs. The co-design allowed for knowledge exchange which led to video presenters becoming vaccine ch ions and clinicians developing a deeper understanding of vaccine hesitancy. Social media data revealed that: sponsored Facebook posts have the largest reach videos shared on a government branded YouTube page had very low impact the popularity of videos was not in proportion to the number of language speakers and there is value in reposting content on Facebook. Effective communication during a health crisis such as the COVID-19 pandemic requires more than a direct translation of a script written by health professionals it involves relationships of reciprocity and a decolonised approach to resource production which centres First Nations priorities and values.
Publisher: Informa UK Limited
Date: 03-04-2022
DOI: 10.1080/14461242.2022.2055484
Abstract: In Australia's Northern Territory (NT) most people who access health services are Aboriginal and most healthcare providers are non-Indigenous many providers struggle to deliver culturally competent care. Cultural awareness training is offered however, dissatisfaction exists with the limited scope of training and the face-to-face or online delivery format. Therefore, we developed and evaluated
Publisher: Oxford University Press (OUP)
Date: 17-04-2018
Abstract: Despite the enormous potential of social media for health promotion, there is an inadequate evidence base for how they can be used effectively to influence behaviour. In Australia, research suggests social media use is higher among Aboriginal and Torres Strait Islander people than the general Australian population however, health promoters need a better understanding of who uses technologies, how and why. This qualitative study investigates what types of health content are being shared among Aboriginal and Torres Strait people through social media networks, as well as how people engage with, and are influenced by, health-related information in their offline life. We present six social media user typologies together with an overview of health content that generated significant interaction. Content ranged from typical health-related issues such as mental health, diet, alcohol, smoking and exercise, through to a range of broader social determinants of health. Social media-based health promotion approaches that build on the social capital generated by supportive online environments may be more likely to generate greater traction than confronting and emotion-inducing approaches used in mass media c aigns for some health topics.
Publisher: Wiley
Date: 04-12-2021
DOI: 10.1002/HPJA.415
Abstract: Improving equitable delivery of health care for Aboriginal people in northern Australia is a priority. This study sought to gauge patient experiences of hospitalisation and to identify strategies to improve equity in health care for Aboriginal patients. Aims were to validate an experience of care survey and document advice from Aboriginal interpreters. Medical charts of Aboriginal patients were audited for documentation of language and interpreter use. Aboriginal inpatients were surveyed using an adapted Australian Hospital Patient Experience Question Set. Multiple‐choice responses were compared with free‐text comments to explore validity. Semi‐structured interviews were conducted with Aboriginal interpreter staff. In 68 charts audited, primary language was documented for only 30/68 (44%) people. Of 73 patient experience survey respondents, 49/73 (67%) indicated satisfaction with overall care 64/73 (88%) indicated hospital staff communicated well in multiple‐choice responses. Respondents who gave positive multiple‐choice ratings nevertheless reported in free text responses concerns relating to social‐emotional support, loneliness, racism and food. Key themes from interviews included the benefits to patients from accessing interpreters, benefits of hospital‐based support for interpreters and the need for further service redesign. Multiple‐choice questions in the survey were of limited utility respondents' free comments were more informative. Social and emotional wellbeing must be addressed in future experience‐of‐care evaluations. Aboriginal patients' language and cultural needs can be better met by improved systems approaches. Aboriginal interpreters are uniquely placed to advise on this. Improving health communication is critical to equitable and effective health care. Interventions must be driven by Aboriginal perspectives.
Publisher: Springer Science and Business Media LLC
Date: 24-08-2020
Publisher: JMIR Publications Inc.
Date: 10-12-2020
DOI: 10.2196/16927
Abstract: Facebook is widely used by Australia’s First Nations people and has significant potential to promote health. However, evidence-based guidelines for its use in health promotion are lacking. Smoking prevalence among Australia’s First Nations people is nearly 3 times higher than other Australians. Locally designed programs in Aboriginal Community Controlled Health Services (ACCHOs) to reduce smoking often use Facebook. This study reports on an analysis of the reach and engagement of Facebook posts with smoking prevention and cessation messages posted by ACCHOs in the Northern Territory, Australia. Each service posted tobacco control content at least weekly for approximately 6 months. Posts were coded for the following variables: service posted, tailored First Nations Australian content, local or nonlocally produced content, video or nonvideo, communication technique, and emotional appeal. The overall reach, shares, and reactions were calculated. Compared with posts developed by the health services, posts with content created by other sources had greater reach (adjusted incident rate ratio [IRR] 1.92, 95% CI 1.03-3.59). Similarly, reactions to posts (IRR 1.89, 95% CI 1.40-2.56) and shared posts (IRR 2.17, 95% CI 1.31-3.61) with content created by other sources also had more reactions, after controlling for reach, as did posts with local First Nations content compared with posts with no First Nations content (IRR 1.71, 95% CI 1.21-2.34). Facebook posts with nonlocally produced content can be an important component of a social media c aign run by local health organizations. With the exception of nonlocally produced content, we did not find a definitive set of characteristics that were clearly associated with reach, shares, and reactions. Beyond reach, shares, and likes, further research is needed to understand the extent that social media content can influence health behavior.
Publisher: Springer Science and Business Media LLC
Date: 22-06-2023
DOI: 10.1186/S13012-023-01276-1
Abstract: The Communicate Study is a partnership project which aims to transform the culture of healthcare systems to achieve excellence in culturally safe care for First Nations people. It responds to the ongoing impact of colonisation which results in First Nations peoples experiencing adverse outcomes of hospitalisation in Australia’s Northern Territory. In this setting, the majority of healthcare users are First Nations peoples, but the majority of healthcare providers are not. Our hypotheses are that strategies to ensure cultural safety can be effectively taught, systems can become culturally safe and that the provision of culturally safe healthcare in first languages will improve experiences and outcomes of hospitalisation. We will implement a multicomponent intervention at three hospitals over 4 years. The main intervention components are as follows: cultural safety training called ‘Ask the Specialist Plus’ which incorporates a locally developed, purpose-built podcast, developing a community of practice in cultural safety and improving access to and uptake of Aboriginal language interpreters. Intervention components are informed by the ‘behaviour change wheel’ and address a supply–demand model for interpreters. The philosophical underpinnings are critical race theory, Freirean pedagogy and cultural safety. There are co-primary qualitative and quantitative outcome measures: cultural safety, as experienced by First Nations peoples at participating hospitals, and proportion of admitted First Nations patients who self-discharge. Qualitative measures of patient and provider experience, and patient-provider interactions, will be examined through interviews and observational data. Quantitative outcomes (documentation of language, uptake of interpreters (booked and completed), proportion of admissions ending in self-discharge, unplanned readmission, hospital length of stay, costs and cost benefits of interpreter use) will be measured using time-series analysis. Continuous quality improvement will use data in a participatory way to motivate change. Programme evaluation will assess Reach, Effectiveness, Adoption, Implementation and Maintenance (‘RE-AIM’). The intervention components are innovative, sustainable and have been successfully piloted. Refinement and scale-up through this project have the potential to transform First Nations patients’ experiences of care and health outcomes. Registered with ClinicalTrials.gov Protocol Record 2008644
Publisher: Wiley
Date: 30-05-2021
DOI: 10.1002/HPJA.364
Publisher: Springer Science and Business Media LLC
Date: 29-05-2020
DOI: 10.1186/S12909-020-02086-5
Abstract: Aboriginal cultural awareness training aims to build a culturally responsive workforce, however research has found the training has limited impact on the health professional’s ability to provide culturally safe care. This study examined cultural awareness training feedback from healthcare professionals working with high Aboriginal patient caseloads in the Top End of the Northern Territory of Australia. The aim of the research was to assess the perception of training and the potential for expansion to better meet workforce needs. Audit and qualitative thematic analysis of cultural awareness training evaluation forms completed by course participants between March and October 2018. Course participants ranked seven teaching domains using five-point Likert scales (maximum summary score 35 points) and provided free-text feedback. Data were analysed using the Framework Method and assessed against Kirkpatrick’s training evaluation model. Cultural safety and decolonising philosophies shaped the approach. 621 participants attended 27 ACAP sessions during the study period. Evaluation forms were completed by 596 (96%). The mean overall assessment score provided was 34/35 points (standard deviation 1.0, range 31-35) indicating high levels of participant satisfaction. Analysis of 683 free text comments found participants wanted more cultural education, designed and delivered by local people, which provides an opportunity to consciously explore both Aboriginal and non-Aboriginal cultures (including self-reflection). Regarding the expansion of cultural education, four major areas requiring specific attention were identified: communication, kinship, history and professional relevance. A strength of this training was the authentic personal stories shared by local Aboriginal cultural educators, reflecting community experiences and attitudes. Criticism of the current model included that too much information was delivered in one day. Healthcare providers found cultural awareness training to be an invaluable entry point. Cultural education which elevates the Aboriginal health user’s experience and provides health professionals with an opportunity for critical self-reflection and practical solutions for common cross-cultural clinical encounters may improve the delivery of culturally safe care. We conclude that revised models of cultural education should be developed, tested and evaluated. This requires institutional support, and recognition that cultural education can contribute to addressing systemic racism.
Publisher: Springer Science and Business Media LLC
Date: 05-10-2022
DOI: 10.1038/S41586-022-05169-Z
Abstract: Pancreatic ductal adenocarcinoma (PDAC) is a highly desmoplastic, aggressive cancer that frequently progresses and spreads by metastasis to the liver 1 . Cancer-associated fibroblasts, the extracellular matrix and type I collagen (Col I) support 2,3 or restrain the progression of PDAC and may impede blood supply and nutrient availability 4 . The dichotomous role of the stroma in PDAC, and the mechanisms through which it influences patient survival and enables desmoplastic cancers to escape nutrient limitation, remain poorly understood. Here we show that matrix-metalloprotease-cleaved Col I (cCol I) and intact Col I (iCol I) exert opposing effects on PDAC bioenergetics, macropinocytosis, tumour growth and metastasis. Whereas cCol I activates discoidin domain receptor 1 (DDR1)–NF-κB–p62–NRF2 signalling to promote the growth of PDAC, iCol I triggers the degradation of DDR1 and restrains the growth of PDAC. Patients whose tumours are enriched for iCol I and express low levels of DDR1 and NRF2 have improved median survival compared to those whose tumours have high levels of cCol I, DDR1 and NRF2. Inhibition of the DDR1-stimulated expression of NF-κB or mitochondrial biogenesis blocks tumorigenesis in wild-type mice, but not in mice that express MMP-resistant Col I. The erse effects of the tumour stroma on the growth and metastasis of PDAC and on the survival of patients are mediated through the Col I–DDR1–NF-κB–NRF2 mitochondrial biogenesis pathway, and targeting components of this pathway could provide therapeutic opportunities.
Publisher: Informa UK Limited
Date: 20-04-2021
Publisher: AMPCo
Date: 25-07-2020
DOI: 10.5694/MJA2.50700
Publisher: Cold Spring Harbor Laboratory
Date: 27-03-2022
DOI: 10.1101/2022.03.25.485695
Abstract: Current approaches to stage chronic liver diseases have limited utility to directly predict liver cancer risk. Here, we employed single nucleus RNA sequencing (snRNA-seq) to characterize the cellular microenvironment of healthy and chronically injured pre-malignant livers using two distinct mouse models. Analysis of 40,748 hepatic nuclei unraveled a previously uncharacterized disease-associated hepatocyte transcriptional state (daHep). These cells were absent in healthy livers, but were increasingly prevalent as chronic liver disease progressed towards hepatocarcinogenesis. Gene expression deconvolution of 1,439 human liver transcriptomes from publicly available datasets revealed that daHep frequencies highly correlate with current histopathological liver disease staging systems. Importantly, we show that high daHep levels precede carcinogenesis in mice and humans and predict a higher risk of hepatocellular carcinoma (HCC) development. This novel transcriptional signature with diagnostic and, more importantly, prognostic significance has the potential to change the way chronic liver disease patients are staged, surveilled and risk-stratified.
Publisher: Springer Science and Business Media LLC
Date: 23-07-2021
DOI: 10.1186/S12939-021-01507-1
Abstract: In hospitals globally, patient centred communication is difficult to practice, and interpreters are underused. Low uptake of interpreters is commonly attributed to limited interpreter availability, time constraints and that interpreter-medicated communication in healthcare is an aberration. In Australia’s Northern Territory at Royal Darwin Hospital, it is estimated around 50% of Aboriginal patients would benefit from an interpreter, yet approximately 17% get access. Recognising this contributes to a culturally unsafe system, Royal Darwin Hospital and the NT Aboriginal Interpreter Service embedded interpreters in a renal team during medical ward rounds for 4 weeks in 2019. This paper explores the attitudinal and behavioural changes that occurred amongst non-Indigenous doctors and Aboriginal language interpreters during the pilot. This pilot was part of a larger Participatory Action Research study examining strategies to achieve culturally safe communication at Royal Darwin Hospital. Two Yolŋu and two Tiwi language interpreters were embedded in a team of renal doctors. Data sources included interviews with doctors, interpreters, and an interpreter trainer reflective journals by doctors and researcher field notes. Inductive thematic analysis, guided by critical theory, was conducted. Before the pilot, frustrated doctors unable to communicate effectively with Aboriginal language speaking patients acknowledged their personal limitations and criticised hospital systems that prioritized perceived efficiency over interpreter access. During the pilot, knowledge of Aboriginal cultures improved and doctors adapted their work routines including lengthening the duration of bed side consults. Furthermore, attitudes towards culturally safe communication in the hospital changed: doctors recognised the limitations of clinically focussed communication and began prioritising patient needs and interpreters who previously felt unwelcome within the hospital reported feeling valued as skilled professionals. Despite these benefits, resistance to interpreter use remained amongst some members of the multi-disciplinary team. Embedding Aboriginal interpreters in a hospital renal team which services predominantly Aboriginal peoples resulted in the delivery of culturally competent care. By working with interpreters, non-Indigenous doctors were prompted to reflect on their attitudes which deepened their critical consciousness resulting in behaviour change. Scale up of learnings from this pilot to broader implementation in the health service is the current focus of ongoing implementation research.
Publisher: Springer Science and Business Media LLC
Date: 20-10-2021
DOI: 10.1186/S12913-021-07159-9
Abstract: In Australia’s north, Aboriginal peoples live with world-high rates of rheumatic heart disease (RHD) and its precursor, acute rheumatic fever (ARF) driven by social and environmental determinants of health. We undertook a program of work to strengthen RHD primordial and primary prevention using a model addressing six domains: housing and environmental support, community awareness and empowerment, health literacy, health and education service integration, health navigation and health provider education. Our aim is to determine how the model was experienced by study participants. This is a two-year, outreach-to-household, pragmatic intervention implemented by Aboriginal Community Workers in three remote communities. The qualitative component was shaped by Participatory Action Research. Yarning sessions and semi-structured interviews were conducted with 14 in iduals affected by, or working with, ARF/RHD. 31 project field reports were collated. We conducted a hybrid inductive-deductive thematic analysis guided by critical theory. Aboriginal Community Workers were best placed to support two of the six domains: housing and environmental health support and health navigation. This was due to trusting relationships between ACWs and families and the authority attributed to ACWs through the project. ACWs improved health literacy and supported awareness and empowerment but this was limited by disease complexities. Consequently, ACWs requested more training to address knowledge gaps and improve knowledge transfer to families. ACWs did not have skills to provide health professionals with education or ensure health and education services participated in ARF/RHD. Where knowledge gain among participant family members was apparent, motivation or structural capability to implement behaviour change was lacking in some domains, even though the model was intended to support structural changes through care navigation and housing fixes. This is the first multi-site effort in northern Australia to strengthen primordial and primary prevention of RHD. Community-led programs are central to the overarching strategy to eliminate RHD. Future implementation should support culturally safe relationships which build the social capital required to address social determinants of health and enable holistic ways to support sustainable in idual and community-level actions. Government and services must collaborate with communities to address systemic, structural issues limiting the capacity of Aboriginal peoples to eliminate RHD.
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/PY19008
Abstract: Many Aboriginal Community Controlled Health Services (ACCHS) embrace Facebook as an organisational tool to share positive stories, which counter the negative narrative surrounding Aboriginal issues. However, the Facebook algorithm prioritises posts on personal pages over organisations. To take advantage of the algorithm, this project paid three Yolŋu employees of a north-east Arnhem Land ACCHS to share quit smoking messages on their personal Facebook pages. Smoking prevalence among Aboriginal and Torres Strait Islander Australians is nearly three-fold higher than non-Indigenous Australians, and previous research has identified the need for culturally appropriate communication approaches to accelerate the decline in Indigenous smoking. This research found Yolŋu participants nurtured healthy behaviours through compassionate non-coercive communications, in contrast to fear-inducing health warnings prevalent in tobacco control. Cultural tailoring of tobacco control messages was achieved by having trusted local health staff sharing, and endorsing, messages regardless of whether the content was Indigenous specific. This research also revealed online Facebook activity does not reflect the reach of posts, which may extend beyond social media users to in iduals who do not have a Facebook profile.
Publisher: Springer Science and Business Media LLC
Date: 21-05-2019
Publisher: Elsevier BV
Date: 02-2023
Publisher: Public Library of Science (PLoS)
Date: 12-10-2021
DOI: 10.1371/JOURNAL.PONE.0257825
Abstract: Aboriginal language interpreters are under-utilised in healthcare in northern Australia. Self-discharge from hospital is an adverse outcome occurring at high rates among Aboriginal people, with poor communication thought to be a contributor. We previously reported increased Aboriginal interpreter uptake and decreased rates of self-discharge during implementation of a 12-month hospital-based intervention. Interrupted time-series analysis showed sudden increase and up-trending improvement in interpreter use, and a corresponding decrease in self-discharge rates, during a 12-month intervention period (April 2018—March 2019) compared with a 24-month baseline period (April 2016 –March 2018). This paper aims to investigate reasons for these outcomes and explore a potential causal association between study activities and outcomes. The study was implemented at the tertiary referral hospital in northern Australia. We used the Template for Intervention Description and Replication (TIDieR) as a framework to describe intervention components according to what, how, where, when, how much, tailoring, modifications and reach. Components of the study intervention were: employment of an Aboriginal Interpreter Coordinator, ‘Working with Interpreters’ training for healthcare providers, and ch ioning of interpreter use by doctors. We evaluated the relative importance of intervention components according to TIDieR descriptors in relation to outcomes. Activities independent of the study that may have affected study findings were reviewed. The relationship between proportion of hospital separations among Aboriginal people ending in self-discharge and numbers of Aboriginal interpreter bookings made during April 2016-March 2019 was tested using linear regression. ‘Working with Interpreters’ training sessions were undertaken at a regional hospital as well as the tertiary hospital. Training evaluation comprised an anonymous online survey before the training, immediately after and then at six to eight months. Survey data from the sites were pooled for analysis. Employment of the Aboriginal Interpreter Coordinator was deemed the most important component of the intervention, based on reach compared to the other components, and timing of the changes in outcomes in relation to the employment period of the coordinator. There was an inverse association between interpreter bookings and self-discharge rate among Aboriginal inpatients throughout the baseline and intervention period (p = 0.02). This association, the timing of changes and assessment of intercurrent activities at the hospital indicated that the study intervention was likely to be casually related to the measured outcomes. Communication in healthcare can be improved through targeted strategies, with associated improvements in patient outcomes. Health services with high interpreter needs would benefit from employing an interpreter coordinator.
Publisher: JMIR Publications Inc.
Date: 05-11-2019
Abstract: acebook is widely used by Australia’s First Nations people and has significant potential to promote health. However, evidence-based guidelines for its use in health promotion are lacking. Smoking prevalence among Australia’s First Nations people is nearly 3 times higher than other Australians. Locally designed programs in Aboriginal Community Controlled Health Services (ACCHOs) to reduce smoking often use Facebook. his study reports on an analysis of the reach and engagement of Facebook posts with smoking prevention and cessation messages posted by ACCHOs in the Northern Territory, Australia. ach service posted tobacco control content at least weekly for approximately 6 months. Posts were coded for the following variables: service posted, tailored First Nations Australian content, local or nonlocally produced content, video or nonvideo, communication technique, and emotional appeal. The overall reach, shares, and reactions were calculated. ompared with posts developed by the health services, posts with content created by other sources had greater reach (adjusted incident rate ratio [IRR] 1.92, 95% CI 1.03-3.59). Similarly, reactions to posts (IRR 1.89, 95% CI 1.40-2.56) and shared posts (IRR 2.17, 95% CI 1.31-3.61) with content created by other sources also had more reactions, after controlling for reach, as did posts with local First Nations content compared with posts with no First Nations content (IRR 1.71, 95% CI 1.21-2.34). acebook posts with nonlocally produced content can be an important component of a social media c aign run by local health organizations. With the exception of nonlocally produced content, we did not find a definitive set of characteristics that were clearly associated with reach, shares, and reactions. Beyond reach, shares, and likes, further research is needed to understand the extent that social media content can influence health behavior.
Publisher: Springer Science and Business Media LLC
Date: 07-03-2023
Location: United States of America
No related grants have been discovered for Michael Karin.