WA Primary Health Alliance (WAPHA) celebrates the cultural history of Aboriginal people and aims to ensure our workforce, services we procure and primary health care services we influence, are culturally competent. The focus of this paper is to discuss the phased approach WAPHA has taken working with Aboriginal people to design and implement an Aboriginal Cultural Competency and Capability Framework.
The burden of disease for Aboriginal people remains 2.3 times greater than for non-Aboriginal communities, and chronic conditions and overweight continue to demonstrate increased prevalence. The social determinants of health influence this, whilst the cultural determinants work to mitigate, and by embedding culturally competent health services, and by prioritising Aboriginal people’s engagement when using mental health, alcohol and other drugs, population health, aged care, and primary health care services, we may close the gap.
Phase One: Best practice review
A literature review of national and state policy, guidance materials, national Primary Health Network activity, best practice recommendations and mapping of WAPHA’s Aboriginal cultural competency activity was achieved.
Phase two: Internal engagement methodology
A survey instrument was designed and administered to staff and qualitative focus groups engaged, to identify strengths of current process, areas for improvement and actions/tools needed to enable staff to implement the framework.
Phase three: External engagement methodology
WAPHA engaged Kambarang Services (Aboriginal owned) to lead external consultation with Aboriginal community members, WAPHA's procured service providers, and peak bodies. We asked:
• What does a safe service look and feel like?
• What are the barriers?
• What makes a service culturally safe?
• How can WAPHA support services to become more culturally competent and safe for all Aboriginal people?

120 Aboriginal community members were consulted on what makes services culturally safe for them, 4 focus groups were held in metropolitan and regional WA, as well as 8 online focused sessions. The description of how this enriched our understanding of stakeholder expectations regarding WAPHA’s approach to cultural safety, the key characteristics for a service to be culturally safe, an overview of the Aboriginal Cultural Competency and Capability Framework, the implementation guide and our next steps will be provided.

Context: Aboriginal community-controlled health organisations (ACCHOs) are constrained by short-term funding models, with burdensome administrative and accountability requirements. These requirements are misaligned with Indigenous priorities that encompass holistic, relational and strengths-based health and wellbeing (HWB) concepts. Mitigating this misalignment, the National Agreement on Closing the Gap (NA-CtG) emphasises access to, and the capability to use, locally-relevant information as foundational to Indigenous-led decision-making. We aimed to develop a model for ACCHOs incorporating Indigenous data sovereignty (IDS) principles as a practical implementation of NA-CtG policies.
Methods: We synthesised findings from a group of Indigenous and non-Indigenous collaborators with years of experience in health program/service delivery and research. This included literature reviews and research related to health program delivery and lived experience of working in health services. Key concepts identified were aligned with the five Maiam nayri Wingara IDS principles: Indigenous control of the data ecosystem (data creation & development, stewardship, analysis, and dissemination); Accessible and available data that is contextual and disaggregated; Data is relevant, empowering sustainable self-determination and effective self-governance; Data structures are accountable to Indigenous peoples; Data is protective, strengths-based and respects Indigenous interests, including after dissemination.
Translational outcomes: Our approach facilitates the development and implementation of new/innovative culturally-informed data, measures and tools aligned to community health priorities and organisational imperatives. Based in Aboriginal research methods and IDS principles, the model includes: 1. A process for the development and evaluation of new measures/tools; and 2. A framework of health service implementation actions. This model aims to enable ACCHOs to have the authority, autonomy and data to put community priorities into action in the planning, delivery and reporting of health programs/services.
Future actions: Rather than further research identifying community HWB priorities, the priority is to translate existing research into practice. We recommend funding studies to implement and evaluate the proposed model.

Context and aim: Indigenous Australians experience disparities in cancer outcomes compared to non-Indigenous people, marked by delayed diagnoses, higher mortality rates and sub-optimal care. Yet research aiming to reduce these gaps typically does not have clear evidence of meaningful engagement. We aimed to collate and assess the quality of research about cancer in Indigenous communities, and report on the extent of Indigenous peoples involvement in the research.

Methods and analysis/research findings: A thematic systematic review was conducted, with 91 included studies, reporting on cancer experiences and supportive care needs within Australian Indigenous communities.

We appraised the quality of the studies using two methodologies: a traditional Westernised tool; and an Aboriginal scholar designed tool, comparing the appraisals to determine differences, and evidence of meaningful engagement with Indigenous populations.

Using the Westernised tool, 96% (n=87) of included articles satisfied all criteria, however using the more comprehensive Aboriginal scholar designed tool, no articles were able to satisfy all criteria, with only 11% of the articles (n=10) satisfying half the tool’s criteria. The appraisal results demonstrated that research outcomes consistently fail to include appropriate consultation and involvement of Indigenous peoples, exacerbated often by journals not providing avenues to support disclosure of this information.

Six key themes emerged: Culture, family, and community; cancer outcomes and survivorship; psychological distress; geographic diversity and access to health care; cancer education and awareness; and lack of appropriate data.

Translational outcomes: The themes culminated in four recommendations to improve cancer care for Indigenous peoples: Provision of co-designed and tailored information; bolstering the Indigenous cancer workforce; cultural training for non-Indigenous healthcare professionals; and improvement of data collection in research and health services.

This review has identified an urgent need for anti-racist research, funding and publication practices, including the prioritisation and inclusion of active engagement with Indigenous peoples throughout these processes.

Future actions: The importance and positive impact of genuinely involving Indigenous voices in cancer research is critical to improve cancer outcomes and reduce disparities. Systems owners, including institutions, funders and publishers, must be accountable for promoting anti-racist practices; which they can do through the prioritisation of work that genuinely involves Indigenous peoples across every stage.

Purpose: Cancer is a leading driver in the health gap between First Nations and non-First Nations people. Prior research has identified cultural safety issues and experiences of racism within cancer care pathways, particularly impacting the wellbeing of First Nations adults. Little is understood about the specific needs and additional barriers confronting by Lesbian, Gay, Bisexual, Trans, Intersex, Queer, Sistergirl, and Brotherboy (LGBTQISB+) First Nations individuals in this context. This systematic review aims to identify and describe the existing evidence base around enablers and barriers contributing to the accessibility of cancer screening for LGBTQISB+ First Nations people in the cancer space. However, research with a specific focus LGBTQISB+ First Nations people within cancer context in Australia is scarce, therefore, the scope of this review was broadened to include LGBTQI2S+ Black, Indigenous and People of Colour (BIPOC) in Canada, Australia, Aotearoa New Zealand, and the United States of America.

Methods: A comprehensive search of MEDLINE, Embase, Web of Science, PsycINFO, Scopus, CINAHL, and PubMed databases was conducted, focusing on qualitative literature pertaining to BIPOC and LGBTQI2S+ populations and cancer screening up to January 2024.

Results: After full text screening, 13 studies were included. Thematic analysis of the literature elicited six key themes: Challenging cisheteronormative knowledge; Tailored information provision; Navigating strategic disclosure; Addressing intersectional discrimination; Self-advocating and initiating conversations; and Paternalistic healthcare dynamics.

Implications: The findings reveal unique experiences of participating in cancer screening and identifies several unmet needs which should be appropriately and systematically addressed.

Future Direction: To bridge the critical research gap, our team is conducting a pilot study to explore and describe experiences of LGBTQISB+ First Nations peoples accessing cancer screening. This pilot study is a research project that centres the views and experiences of LGBTQISB+ First Nations people with the aim of improving the delivery of appropriate early detection and cancer screening for LGBTQISB+ First Nations peoples that is culturally safe, supportive of sexuality and gender identity, and ameliorates the discrimination related barriers to cancer care. The lead author will be discussing findings from the systematic review, how it has shaped the research project design, the pilot study preliminary findings and future direction.

Findings of this study will inform equitable, accessible, culturally appropriate strategies to improve access to cancer screening that supports the holistic wellbeing of LGBTQISB+ First Nations peoples.

Background: Widespread racism is an enduring legacy of colonisation and is deeply entrenched in Australian society, systems, and structures. Despite extensive documentation of experiences of racism by First Nations peoples, the ongoing impacts of racism, in all its forms, on the wellbeing of First Nations peoples has received limited attention. Drawing upon narratives from a national qualitative study focusing on the positive aspects of wellbeing, the research illuminates how participants spontaneously disclosed experiences of racism as integral components of their life stories.
Aims: This study aimed to qualitatively explore the complex pathways through which racism is impacting on the wellbeing of First Nations adults.
Methods: First Nations adults were recruited from around Australia to participate in Yarning Circles led by First Nations facilitators about wellbeing. A First Nations-led secondary reflexive thematic analysis was conducted to describe the pathways through which racism impacts on wellbeing.
Results: 359 First Nations adults participated in one of 45 Yarning Circles or six Individual Yarns. Our analysis revealed the following seven pathways through which racism impacts the lives of First Nations adults: threatening cultural survival; undermining kinship systems; denigrating First Nations systems of power and justice; battling stereotypes; harming mental health; undermining identity, and pride; and challenging the right to self-determination and sovereignty.
Conclusion: Our findings highlight the wide-ranging and complex pathways through which racism impacts First Nations adults’ wellbeing and add to mounting calls for urgent action to eradicate racism, in all its forms, in Australia.
This research highlights the deeply entrenched nature of racism in Australian society, rooted in colonial history and ongoing structural inequities. Despite efforts to promote wellbeing and resilience, racism continues to undermine the health and social fabric of First Nations communities. The findings underscore the urgent need for comprehensive strategies to address racism at all levels, from individual attitudes and behaviours to institutional policies and societal norms. By privileging the voices and experiences of First Nations peoples, this research contributes to a deeper understanding of the complex intersections between racism and wellbeing and provides critical insights to guide future research, policies, and programs aimed at promoting equity and social justice in Australia.