Objective: The Australian cervical cancer screening program invites eligible people to participate in this free program, every 5 years. It is estimated that only one third of people with a disability, participate in the program. Low participation has been attributed to barriers, such as inaccessible services, stigma, and poor communication with health professionals. Sexual Health Quarters is seeking to co-design the ideal cervical screening program with and for people with disability.

Methods: Between March and August 2025, SHQ consulted with 98 individuals with disability, 11 carers of people with disability and 18 service providers, to explore barriers and enablers of participation in cervical screening and the components for the ideal model of care. Data were collected via surveys, interviews, and focus groups, and analysed using descriptive statistics and thematic analysis.

Results: Four key themes emerged: 1) previous experiences with cervical screening tests; 2) knowledge of importance of screening; 3) recommendations for a home-based outreach model; and 4) elements of the ideal model of care. While most participants called for outreach screening due to increased comfort and accessibility, others expressed some concern about privacy in shared accommodation, safety of home visits, and the need for culturally sensitive care. Overall participants recommended provision of trauma-aware, person-centred care; flexibility in appointment location; use of accessible and inclusive communication formats; female clinicians; interpreter availability; and allowance for support persons during procedures.

Conclusion: The findings indicate strong recommendation for an outreach service, provided it is designed around individual needs and community preferences. This consultation represents the first stage of a co-designed program and offers practical guidance for developing equitable and scalable cervical screening services for people with disability.

Background
People with intellectual disability and complex support needs in Australia experience violence, abuse and neglect, particularly in congregate settings. Some families report that individualised living and support models, such as “service-for-one,” where support workers are directly employed by the family instead of through an agency, offer greater safety and autonomy, but there is limited formal evidence.

Methods
This pilot project co-designed a research strategy to evaluate service-for-one, with a focus on safety. The study was a partnership between University of Melbourne and Inclusion Australia, the peak body for people with intellectual disability and their families. A governance group comprising researchers, community organisation representatives, and people with lived-experience guided the design. Semi-structured interviews were conducted with family members, while flexible, tailored approaches were used with people with intellectual disability. Collaborative case studies were developed.

Results
Four families completed interviews, including two parent–person dyads (n=6). Findings highlight the feasibility of co-designed methods and early insights into how safety, choice, and control are understood service-for-one arrangements.

Main messages
• People with intellectual disability face heightened risks of violence and neglect in congregate settings, prompting interest in individualised alternatives such as service-for-one.
• This pilot study co-designed and tested a research approach to evaluate the safety of service-for-one through lived experience–led governance and flexible methods.
• Early findings suggest co-designed methods are feasible and provide valuable insights into how safety, choice, and control are experienced in service-for-one arrangements.

Co-design is an established practice for working collaboratively with communities and consumers in public health service design. While co-design has been championed as a tool for public health research and is building momentum in the design of general health curriculum, co-design of public health curricula is relatively new.

Challenges for first year public health education include diverse student backgrounds, the need to connect theory to specific examples in practice and working with large cohorts. To address these challenges, we undertook a collaborative and co-design informed approach to redevelop a large first-year undergraduate Public Health unit.

While ‘third space’ [academic support] teams have long been part of the sector, workload demands, disciplinary identity and perceived hierarchy often limit opportunities for genuine collaboration with academics. In this project we used McKercher’s (2020) principles of co-design; sharing power, prioritising relationships, using participatory means and building capability, throughout as a foundation for respectful, values-led collaboration.

By adopting an iterative, dialogic approach, the process created collaborative spaces with a third space team, comprising of teaching and learning staff, learning designers, librarians and an academic skills advisor for shared interpretation, meaningful dialogue and rapid prototyping. Informal student input was also incorporated. Curriculum materials were refined collaboratively, drawing on learning designers’ pedagogical and design insights and academics’ disciplinary and practice-based expertise. This approach enabled embedding of inclusive and accessibility principles informed by Universal Design for Learning and tailored learning supports for the diverse cohort. These processes directly addressed challenges of scale, variable student preparedness, and the need for clearer scaffolding, with impacts evident in shifts in teaching approach, improved student navigation of unit site, stronger engagement with learning and improved performance across assessment tasks.



Reference

McKercher, K. A. (2020). Beyond sticky notes: co-design for real: mindsets, methods and movements, Sydney, Australia: Beyond Sticky Notes

Background and aim: South Asian (SA) migrants are one of the fastest growing migrant populations in Australia and are at increased risk of cardiovascular disease and related chronic conditions compared to other ethnic groups. Cardiometabolic risks may change with duration of residence and lifestyle factors, but evidence is limited. This study aimed to examine the associations of duration of residence and lifestyle with cardiometabolic and mental wellbeing among SA migrants living in Sydney, Australia.
Methods: A cross-sectional study was conducted among South Asian migrants aged ≥18 years who had resided in Australia for at least one year, excluding temporary migrants. Participants (n=306) were recruited through convenience and snowball sampling using community organisations and social media platforms. Data on lifestyle, cardiometabolic outcomes and mental well-being were collected via an online questionnaire. Descriptive statistics and multivariable logistic regression analyses were performed
Result: Most of the participants were from Bangladesh (32%), India (26%), and Nepal (23%), had a mean±SD age of 37.6±14.1 years, 55% were female, and the median(IQR) duration of residency was 5(2-10) years. Unhealthy lifestyle and poor mental wellbeing were common; 16% were current smokers, one-third were not achieving at least 30 minutes of exercise on any day during the past week, 60% classified as overweight/obese, and around two-thirds screened positive for probable depression or anxiety. In multivariable adjusted model, long term residency (>10 years) increased the odds of overweight/obesity compared with shorter residency (1–5 years; AOR=3.76, 95% CI:1.30–10.89, p=0.015). On the other hand, residency duration of 6–10 years increased the odds of probable depression compared with longer ( >10 years) residency (AOR=4.43, 95% CI:1.61–12.15, p=0.004). Participants consuming fast food 1–3 times/week had higher odds of overweight/obesity (AOR=3.43, 95% CI:1.08–10.85, p=0.036), while participants without daily green vegetable intake had higher odds of high cholesterol (AOR=4.33, 95% CI:1.08–17.36, p=0.039). Moderate exercise was associated with lower odds of probable depression (AOR=0.49, 95% CI:0.26–0.93, p=0.029) and probable anxiety (AOR=0.47, 95% CI:0.25–0.86, p=0.015).
Conclusion: SA migrants experience a high burden of psychological distress during the settlement and adaptation period, while longer duration of residence is associated with increased cardiometabolic risk. Early culturally tailored interventions targeting lifestyle behaviours and mental wellbeing will ultimately reduce long term cardiometabolic risk.

Effective health communication with children is a public health challenge. In practice, children are predominantly positioned as topics in health communication between health professionals and their families, rather than being part of it. Drawing on a study exploring what New Zealand Southeast Asian migrant children and their families need for effective health communication, this presentation proposes a shift to centring children as primary interlocutors alongside their families in health communication. By doing so, health communication with children is moving beyond simply providing information to empowering them to be active in their own healthcare, which is a step towards ensuring children have healthier futures.

A “CHILD” approach (Clarify, Health education materials, Interactive and inclusive approach, Language, and Decoration), crafted from insights from children and their families to guide health communication practice for health professionals, is provided to offer practical guidance on communicating health information to migrant children, focusing on how to deliver it effectively to foster comprehension. Such a child-oriented approach is solution-focused and feasible, as it supports small, manageable shifts in health professionals’ practice, rather than large system shifts. Therefore, immediate impact can be achieved at the individual level by meeting the health communication needs of Southeast Asian migrant children.

This presentation, which foregrounds children’s voices to inform practice from a health communication perspective, has the potential to address health inequity, support children towards healthier futures, and strengthen health professionals’ roles, especially those who work closely with children, by moving from working for children to working with children.

Implementation science (IS) has been held, for some time now, as the way to address widespread public health issues. However, there remains a significant gap in how effectively the field advances equitable health outcomes for populations experiencing social and structural barriers. Recognising and addressing this limitation is essential for progressing IS within the health equity agenda.

The importance of centring equity within IS is widely recognised and accompanied by growing discourse around the role of implementation outcomes. The most widely measured outcomes in IS are those outlined in Proctor et al.’s original taxonomy.

IS and implementation outcomes have been developed through a dominant western epistemological perspective. The growing dialogue nationally and globally on decolonising health research, emphasise the need to critically re-examine how IS measures success, particularly in relation to health equity. In response, we are proposing the addition of a new measure of implementation outcome; - Socio-cultural responsivity. Socio-cultural responsivity is described as a person- and community-centred, strengths-focused, and humanising approach that acknowledges cultural difference, respects cultural preference, and actively integrates social and cultural dimensions into practice.

This presentation will explore how socio-cultural responsivity can be conceptualised within and alongside proctor’s original taxonomy and how this viewpoint is greatly missing in implementation outcomes. We will finish by proposing a forward-looking agenda for embedding this critical approach to IS in the Public Health/health equity space.

Learning outcomes
The audience will:
- Develop a deeper understanding of the limitations within current implementation science and translational research approaches for advancing health equity.
- Gain insight into an expanded vision for the future of implementation science that centres equity, community responsiveness, and public health impact.
- Understand the concept of socio-cultural responsivity and its potential application as a measurable implementation outcome within community and public health contexts.

Background/Purpose:
Young people aged 15–29 continue to experience the highest rates of sexually transmissible infections (STIs) in Australia and are a critical cohort for prevention efforts such as strengthening education, STI screening and referral to treatment.

Approach:
A multidisciplinary team from Gold Coast Public Health Unit and Gold Coast Sexual Health Service (GCSHS) collaboratively created an outreach model-of-care to service young people aged 16 to 29. This model delivers flexible, low-barrier sexual health education and chlamydia and gonorrhoea screening at youth-specific events or hubs on the Gold Coast. The concept has been purposefully designed to empower young people with education focused on increasing awareness, knowledge, approachability and navigation of sexual healthcare and screening, complimented with free safer sex products.

Outcomes/Impact:
Across 14 outreach events, the service tested 356 young people with an average positivity rate of 5%. Those who tested positive were provided treatment abiding by standard GCSHS protocols. At the most efficient outreach event, 88 people were tested in four hours. This averaged 22 tests/hour, compared with the four tests/hour typically achievable in a traditional walk-in clinic setting. Demographic data demonstrated the service’s appeal to first time testers (55%), as well as other priority sub-populations such as those born outside of Australia (51%). Conversations and quotes from young people identified gaps in knowledge of consent for international and culturally diverse students, and in STIs and STI transmission for those in the adolescent or early young adult cohort. Engagement with young people illustrated a clear need for more accessible youth-friendly sexual health information, leading to the development of the ‘Our Sexual Health Information Hub’ online Taplink resource.

Innovation and Significance:
The proven success and efficacy of this outreach model has supported integration into existing Gold Coast Health service delivery, with hopes to adapt and expand to other priority populations.

Introduction
Expanding access to free childcare alongside community-based physical activity programs is a potential strategy to reduce inequities in physical activity among low-income mothers. This study targets mothers experiencing socioeconomic disadvantage, a population with consistently low physical activity levels due to structural barriers such as cost, lack of time, and caregiving demands. Without addressing these barriers, physical activity interventions risk low engagement and limited impact.

Methods
This presentation will share early insights from an in-progress cluster randomised controlled trial in New York City testing three approaches: (A) free weekly fitness classes; (B) fitness classes plus free childcare; and (C) fitness classes, free childcare, and structured peer support. Physical activity is assessed via accelerometers and self-report, with additional measures of mental health, social support, and program participation. Ethnographic methods are used to understand who the intervention works best for and why.

Results
To date, 682 participants have enrolled across seven waves, and data collection is ongoing for the final wave. In the first pilot wave (n=67), self-reported moderate to vigorous physical activity increased by 37% in arm A, 53% in arm B and 96% in arm C. Among the first six waves (n=689), retention was 75%. While analysis of the RCT outcomes will not be undertaken until data collection is complete, emerging insights from qualitative data highlight childcare as a critical enabler of participation. In its absence (Arm A), participants often bring their children to fitness classes, underscoring unmet need. Participants also report benefits extending beyond attendance to fitness classes, including social connection and improved wellbeing.

Conclusion
We will use this Ideas in Action session to share learnings from this ongoing study and spark conversations on how similar models integrating free childcare, accessible fitness programs, and community-building could be adapted and scaled in the Australian context to address health inequities.

Rural LGBTQA+ youth continue to experience significant barriers to safe and inclusive primary healthcare, including stigma, discrimination, limited service availability and a scarcity of youth-specific care. The overall limited availability and capacity of rural healthcare providers is further compounded by the paucity of safe LGBTQA+-inclusive spaces. Despite growing calls for the development of safer primary healthcare spaces (S-PHC-S), evidence-based intersectional approaches remain largely absent, particularly in Australia. This project applies an innovative community-engaged systems approach, combining community-based system dynamics and co-design, to collaborate with LGBTQA+ youth aged 12–25, healthcare professionals, and other system-level stakeholders across rural Western Victoria to create a qualitative and quantitative systems model of S-PHC-S.

Across five group model building (GMB) workshops, participants will co-design a systems map of S-PHC-S by identifying the interacting structures, relationships, and feedback loops shaping healthcare safety for rural LGBTQA+ youth, alongside community-prioritised action areas. The qualitative systems modelling will be complemented by a systematic literature review examining effective primary healthcare initiatives for LGBTQA+ populations, as well as quantitative simulation modelling to test the potential impacts of the co-designed model and action ideas on primary healthcare safety over time. Together, the approach aims to support evidence-informed planning, community-led action, and sustainable systems change. Lived experience, region-wide collaboration, and community ownership are prioritised to support meaningful participation and power-sharing throughout the process. To date, an accessible, youth-centred GMB process has been co-designed, and recruitment of additional workshop participants beyond existing collaborators commenced in February 2026 through the previously established trusted networks - the Queer Health Alliance and Young Queer Collective. This work aims to demonstrate how systems thinking can support collaborative and empowering public health action. By co-designing S-PHC-S, the project addresses healthcare disparities, supports health equity, and provides practical guidance for inclusive, community-centred systems change for marginalised communities in Australia and beyond.

Background: People living with cardiometabolic conditions frequently experience social isolation, fragmented care, and limited access to community-based supports that influence long-term health and wellbeing. These challenges disproportionately affect culturally and linguistically diverse, regional, and socioeconomically disadvantaged populations. Although social prescribing has emerged internationally as a promising approach to connect people with non-clinical supports, scalable and integrated delivery models remain limited in Australia.
Idea: Connect4Health is a digital-enabled social prescribing model designed to integrate healthcare, community services, and peer support for people living with cardiometabolic conditions. Connect4Health combines person-centred assessment, digital referral pathways, and AI-supported navigation to connect individuals with tailored local and digital supports, including peer groups, physical activity programs, health services, and culturally relevant community resources. A multilingual AI Companion will provide ongoing personalised support, facilitate engagement, and identify individuals requiring additional human-delivered care. Connect4Health combines digital infrastructure with existing community-based link workers and health professionals to support coordinated, person-centred care beyond the hospital or clinic setting.
Approach: Connect4Health will be co-designed with people with lived experience, clinicians, community organisations, and implementation partners across metropolitan communities in Victoria. The program will prioritise equity, accessibility, and cultural responsiveness, including support for people with lower digital and health literacy. Continuous evaluation and optimisation processes will use participant feedback, implementation data, and real-world service engagement to refine delivery and support integration within existing health and community systems.
Potential Impact: Connect4Health proposes a scalable and policy-relevant model to strengthen integration between health and social care for people with chronic conditions. By improving access to social and community supports, the program aims to enhance social connectedness, self-management, and quality of life while reducing fragmentation in chronic disease care. Connect4Health has the potential to inform future digitally enabled approaches to integrated public health and chronic disease management across diverse Australian communities.

Solution/Proposal/Insight
The co-designed Benchmarking for Healthy Stores model utilises a continuous improvement cycle of annual assessment, feedback, action planning and implementation to support health-enabling policy and best-practice in food retail in remote Aboriginal and Torres Strait Islander communities. Implementers of the model (store directors, store owners, managers and nutritionists) report it provides structure for Aboriginal and Torres Strait Islander store directors to exercise leadership around prioritising community health in store policy, and positive changes in the healthiness of store policy, operations, and relationship building between nutritionists and store personnel.

Evidence/Research
Aboriginal and Torres Strait Islander leadership in decision-making to improve food systems in remote Australia is fundamental to closing the gap in diet-related ill-health and food security. While there is great diversity in the governance of community stores, many have a community-elected board of Aboriginal and Torres Strait Islander directors with decision-making responsibilities for the pricing, promotion, placement and products in stores. With access to data through health benchmarking, store directors can exert considerable influence over healthiness of remote community store food environments. Interviews with 38 Benchmarking implementers representing 14 Northern Territory remote community stores explored the feasibility (defined as acceptability, practicality and implementation [1]) and benefits of Benchmarking from implementers’ perspectives.

Impact/Application/Action
In its application to the remote stores’ context, the evidence generated through the Benchmarking model strengthened health-enabling best-practice and policy adoption by remote community store directors and/or owners. ‘It’s good that we get your information… so we can see what we are doing... Now that I’ve seen the result it’s going good. I think I’m on the right track with what I need’ – Store director. The non-remote Australian and global food retail sectors could follow this powerful example from remote community store directors to address global community and planetary ill-health.

[1] Bowen et al. (2009) AmJPrevMed 36(5):p452-7.

Aboriginal and Torres Strait Islander Governance
The Benchmarking for Healthy Stores in Remote Aboriginal and Torres Strait Islander Communities project was co-designed in response to calls from community-controlled health organisations and remote retail store groups for benchmarking in remote stores to improve health promoting policy and practice. It was informed by decades of collaboration between researchers and Aboriginal and Torres Strait Islander-led organisations and communities, many of whom were active partners in the research. The collaborative and diverse team spread across many remote communities includes Indigenous Allied Health Australia, Arnhem Land Progress Aboriginal Corporation, Outback Stores, Sunrise Health Service, Katherine West Health Board, and Miwatj Health Aboriginal Corporations, Monash University, Menzies School of Health Research, The University of Queensland, Curtin University, and the Northern Territory Government. The Benchmarking project is governed by a steering group, executive team, and codesign working group, all comprised of Aboriginal and Torres Strait Islander and non-Indigenous researchers and representatives of partner organisations, who ensure that all research processes are culturally appropriate and meaningful, and Aboriginal and Torres Strait Islander data sovereignty principles are upheld.

The "issue"

Disasters do not affect everyone equally. Emergency management fails when Indigenous peoples are treated as stakeholders instead of leaders. Self-determination is not a symbolic gesture; it is the difference between responses that impose solutions and those that protect people, culture, community, and Country.

Public health emergency management is a continuous process of prevention, preparedness, response, and recovery aimed at protecting and supporting communities before, during and after emergencies. Incident Management Teams (IMTs) coordinate and manage emergency responses, including oversight of key functions such as leadership. Although many health policies, guidelines and frameworks urge organisations to embed cultural governance into IMT structures to allow self-determination, very few know how.

The proposal

Inclusive public health strategies that incorporate the needs, perspectives and leadership of Indigenous peoples and other priority populations are essential for building effective public health responses for all.
Health Protection NSW (HPNSW) within NSW Health has embedded an Aboriginal Public Health Function within IMT structures. This function was designed and developed under comprehensive cultural oversight which further strengthens support for the structure.
The Aboriginal Public Health Function serves a dual purpose. First, it supports strategic and operational decision-making that is culturally safe and directly addresses unmet public health needs of Aboriginal peoples of NSW. Second, it embeds Aboriginal cultural governance into the public health emergency response, ensuring culturally appropriate decision-making that supports better health outcomes through culturally safe interventions.
The Aboriginal Advisor role is a state-based leadership role within the Aboriginal Public Health Function. The role shares strong connections with the NSW Aboriginal Health Protection Subcommittee, a rich source of cultural intelligence.

The impact

• Embedding Aboriginal leadership and self-determination in emergency management is a long-term process that requires adaption over time.
• Workforce, representation, and a whole-of-health commitment are required for its success.
• The Aboriginal Advisor role will enhance cultural inclusion in HPNSW IMT operations, strengthen trust and engagement with Aboriginal agencies and communities, and identify unmet needs of Aboriginal peoples to improve health outcomes.

Gippsland spans 41,556 km² and is home to over 300,000 people, yet experiences a disproportionately higher burden of disease compared to the Victorian state average. Despite the well-established benefits of clinical trials in improving patient outcomes and advancing care, participation in regional communities remains persistently low due to structural barriers including distance, time, financial constraints, and limited awareness. In response, Latrobe Regional Health (LRH) established a dedicated research unit in 2019 to expand access to trials, prioritising those that address the needs of vulnerable populations and conditions associated with poorer health outcomes. However, equitable access extends beyond availability, it requires meaningful engagement with communities whose voices are often underrepresented in clinical research design and recruitment. Regional populations are diverse and complex, frequently characterised by agricultural and industrial workforces, lower socioeconomic status, ageing demographics, and limited access to health literacy and digital infrastructure. These factors contribute to both reduced awareness surrounding clinical trials and lower participation, reinforcing inequities in healthcare access and outcomes. Recognising this gap, LRH has partnered with Sanofi to co-design and implement an innovative community engagement program grounded in listening, trust-building, and cultural responsiveness. This initiative seeks to transform how trials are experienced in regional settings by actively engaging local voices to shape outreach strategies, improve health literacy and address barriers to participation. By centering community insight and fostering cross-sector collaboration, this program moves beyond traditional recruitment approaches to establish a scalable, community-informed model for inclusive clinical research. It represents a shift from passive access to active empowerment, ensuring that regional communities are not only included in clinical trial programs, but are actively shaping them. This work demonstrates how intentional partnerships and locally tailored engagement strategies can drive greater diversity in clinical trial participation, ultimately contributing to more equitable health outcomes and strengthening the outcomes of clinical research.

Objective
To assess psychometric properties of the Household Food Insecurity Access Scale (HFIAS) among Aboriginal and Torres Strait Islander People and to evaluate its alignment with Aboriginal and Torres Strait Islander conceptualisations of food security.

Methods
Participants included 219 Aboriginal and Torres Strait Islander individuals from the South Australian Aboriginal Birth Cohort study. Psychometric analyses assessed item redundancy, network structure, item stability, model fit, reliability and criterion validity of the HFIAS. A directed content analysis examined conceptual alignment between HFIAS items and the seven pillars of the National Strategy for Food Security in Remote Aboriginal and Torres Strait Islander Communities (2025–2035), with items reviewed against each pillar’s definitions and intended outcomes.

Results
HFIAS demonstrated a unidimensional structure with adequate item stability, model fit, and reliability. Content analysis demonstrated limited alignment between the HFIAS items and the seven pillars of the National Strategy for Food Security in Remote Aboriginal and Torres Strait Islander Communities (2025–2035). Partial alignment was observed for Health and Nutrition, Families and Communities, and Healthy Economies, but was largely restricted to household-level access hardship, with limited representation of structural, cultural, and system-level determinants.

Conclusion
Although the HFIAS demonstrated acceptable psychometric performance, it captures only a narrow component of food security as conceptualised in Indigenous frameworks. Reliance on this measure alone risks overlooking the broader structural, cultural, environmental, and governance dimensions that underpin food security for Aboriginal and Torres Strait Islander peoples. More comprehensive assessment requires complementary, culturally grounded measures aligned with Indigenous-led policy priorities.

References:
1. Coates J, Swindale A, Bilinsky P. Household Food Insecurity Access Scale (HFIAS) for measurement of food access: indicator guide: version 3. 2007.
2. Government) NNIAAA. National Strategy for Food Security in Remote Aboriginal and Torres Strait Islander Communities. Canberra2025.
3. Merrick J, Chong A, Parker E, Roberts-Thomson K, Misan G, Spencer J, et al. Reducing disease burden and health inequalities arising from chronic disease among Indigenous children: an early childhood caries intervention. BMC public health. 2012;12:1-6.

Aboriginal Governance Structures:
The South Australian Aboriginal Birth Cohort Study was co-designed with Aboriginal communities in South Australia and is guided by strong Indigenous governance structures. The study received ethical approval from the Aboriginal Health Council of South Australia and relevant Human Research Ethics Committees.
An established Aboriginal Reference Group provides ongoing governance and oversight of all study activities, ensuring that research priorities, processes, interpretation, and dissemination align with community values, cultural protocols, and Aboriginal ways of knowing. The Reference Group works in partnership with Aboriginal Community Controlled Health Organisations (ACCHOs), researchers, and a Senior Aboriginal Research Officer to guide decision-making across all phases of the study.
Principles of Indigenous data sovereignty are supported through Aboriginal leadership and oversight of data collection, analysis, interpretation, and dissemination. Research findings are reviewed through Indigenous governance structures to ensure that data are used respectfully, accurately represent community perspectives, and contribute to community benefit. The study prioritises reciprocal relationships, accountability to communities, and ongoing consultation throughout the research process.
Culturally appropriate engagement has been maintained through long-term partnerships with ACCHOs and Aboriginal communities. Participants are regularly informed about study progress and findings through newsletters, community presentations, and social media platforms. Members of the Aboriginal Reference Group have also participated in the dissemination of findings at national and international forums, supporting Indigenous leadership in knowledge translation and stewardship of Aboriginal data.

‘Ngala Bidi’ is an Aboriginal-led model of care designed to improve cultural safety, strengthen patient engagement and reduce incomplete episodes of care for Aboriginal and Torres Strait Islander (ATSI) patients in Fiona Stanley Hospital’s Emergency Department. The program offers a practical response to a persistent public health challenge: unequal access to timely, culturally appropriate and relationship-based emergency care.

ATSI people experience a disproportionate burden of disease relative to non-Indigenous Australians. Emergency departments serve as critical access points for populations with limited primary care engagement, and ATSI people present to EDs at higher rates compared to non-Indigenous Australians. At FSH, a tertiary hospital servicing a South Perth catchment population of approximately 724,504 people, around 20,027 identify as ATSI. ATSI patients are discharged against medical advice at a rate of 3.8% of hospital admissions, compared with 0.7% among non-Indigenous patients, representing more than a five-fold disparity.

Under the purview of the Fiona Stanley Aboriginal ED Access Committee, Ngala Bidi is implemented through a structured care pathway that guides the patient journey. The program is centred on early and appropriate identification of Aboriginal status, culturally welcoming signage and space within ED, and Aboriginal Liaison Officers, Aboriginal Health Workers and Aboriginal Health Practitioners who support culturally safe care alongside ED staff.

Key components include clinical yarning, early Aboriginal-led engagement, recognition of patients at risk of disengagement while waiting, flexibility around earlier clinical review where appropriate, and supported continuity of care if patients leave before assessment. Follow-up contact within 24–48 hours is included where possible.

Implementation and evaluation are ongoing using Did Not Wait and Discharged Against Medical Advice rates, Aboriginal identification rates, patient feedback and staff capability measures. Planned expansion to Rockingham ED and Peel Health Campus ED provides an opportunity to translate Ngala Bidi from a local ED initiative into a broader South Metropolitan Health Service model of culturally responsive emergency care.

The Ngala Bidi program is supported by an Aboriginal governance structure through the Fiona Stanley Aboriginal ED Access Committee and associated working group. Aboriginal leadership is embedded through the involvement of Aboriginal program and research officers, Aboriginal Liaison Officers and Aboriginal Health staff in the development, implementation and review of the model of care.

Governance and working group meetings include representation from the Aboriginal Health Strategy team within South Metropolitan Health Service, Aboriginal Health teams from other hospital sites including Rockingham General Hospital and Peel Health Campus, an Aboriginal Consumer Representative, and an Aboriginal Community/Carer Representative. This ensures that program development is informed by Aboriginal staff, consumer and community perspectives.

Given Fiona Stanley Hospital’s role as the largest tertiary hospital within the network, the working group determined that the program should be implemented first at FSH before planned expansion to other South Metropolitan Health Service emergency departments. This staged approach allows the model to be tested, refined and evaluated in a high-volume clinical environment prior to broader implementation.

Indigenous data sovereignty principles are supported by ensuring that data is used for service improvement, accountability and culturally safe care. Data relating to Aboriginal patient identification, DNW rates, DAMA rates, patient feedback and staff capability are considered within the Aboriginal governance structure to guide program refinement and ensure interpretation remains culturally appropriate.