Chronic respiratory disease is a major health problem in rural and remote Aboriginal communities. While rates of conditions such a bronchiectasis, asthma, and COPD are high in these settings, it is the absence of comprehensive and accessible respiratory care that arguably defines poor long-term health outcomes. We describe the establishment of an integrated adult respiratory clinic in rural NSW and the centrality of Aboriginal Health Workers and Practitioners (AHW/Ps) to its ongoing success.
The clinic was initiated during the 2011 swine flu pandemic as door knocking initiative to deliver immunisation and spirometry care to Indigenous community members of Moree and Narrabri. The value of providing ongoing respiratory care was subsequently identified by the Medical Outreach Indigenous Chronic Disease Program and an ongoing tri-annual respiratory clinic was established.
From their inception, the role of Aboriginal Health Workers and Practitioners (AHW/Ps) has been central to the design and delivery of the respiratory clinics. An AHW/P-led wraparound model has been established to coordinate all aspects of clinic attendance and provide continuity of care. AHW/P roles encompass liaison with attendees to prior during the lead up to clinics to identify priorities, concerns, and logistical challenges, ensuring cultural safety and providing support to attendees during clinics, and and to schedule transport, clinical assessments during clinics, and coordinating referrals, rehabilitation clinics, and linkage with other healthcare platforms during the follow-up period.
The clinics have acted as a foundation for several major research initiatives that employ an AHW/P led approach to addressing the respiratory health needs of local communities. The first study aims to inform service provision by determining the unmet respiratory disease burden within each community. The second involves the development of an effective and culturally appropriate model of care, tailored specifically to the needs and priorities of each individual, through a community-led co-design process. In each case, AHW/Ps involvement acts a critical link between community voices and service design. We will describe the success and practical considerations of providing ongoing Indigenous respiratory outreach clinics in remote NSW communities.

Introduction:
Children require a nutrient-rich diet to foster growth, development, and long-term health (Love et al., 2020). In the June quarter of 2023, 49.2% of children aged 0 to 5 utilized approved Early Childhood Education and Care (ECEC) services (DOE, 2023). These facilities may see a child spending nearly 10,000 hours before starting school (Thorpe et al., 2020). Thus, ECECs present a pivotal setting to enhance the quality of a child's nutrition.

Research Question:
What factors support early childhood nutrition, as indicated by staff in ECEC centres within the Darwin, Palmerston, and Katherine regions of the Northern Territory (NT)?

Methods:
An online, anonymous survey was conducted to identify the needs of ECEC services relating to nutrition, aiming to guide future quality improvement initiatives in Darwin, Palmerston, and Katherine.

Results:
21 educators responded to the survey. Ninety-five percent of survey respondents provided meals at their centres and maintained a written menu. Food was primarily sourced from supermarkets and prepared by designated cooks. Educators recommended imparting information on healthy eating to parents and supporting cooking activities for children. They expressed interest in 1-2hour workshops for their own Continuous Professional Development (CPD) and requested guidance on general healthy eating, creating healthy menus, fostering healthy mealtimes, and preparing nutritious meals on a budget. Additionally, 75% of educators sought recipe suggestions, while 55% requested healthy eating posters for their centres, these were the most popular responses. Eighty-five percent of centres reported having a nutrition policy, with 40% derived from head office.

Conclusion:
Our survey investigating nutrition facilitators in Early Childhood Education and Care (ECEC) centres in the Northern Territory (NT) emphasizing opportunities for future initiatives. These discerned gaps resonate with broader trends observed in Australian ECEC centres, which frequently express the need for accessible and user-friendly nutrition-focused resources for staff (Kirkrgaard et al., 2023).

Problem: Young People in East Arnhem land who do not engage in the education system are at increased risk of worse health outcomes, unemployment and poorer social outcomes.

What You Did: Miwatj Health Aboriginal Corporation’s Djamarrkuli’wu Mulka program aims to promote inclusion in the education system by providing sports, music, camps and other activities, to re-engage children in school, whilst also teaching sportsmanship and discipline. Our proactive approach engages young Yolŋu in dynamic health education, fostering safe spaces and promoting open dialogue. DwM showcases the efficacy of Yolŋu-led interventions, instilling cultural pride and amplifying innovative approaches to complex challenges. We strategically navigate the complexities of delivering impactful programs in resource-limited settings, advocating for solutions that bridge the gap between urgent preventive health needs and community-specific challenges.

Results: Our advocacy through DwM demonstrates the tangible impact of Yolŋu-led healthcare on young people in our communities. By leveraging the strength of Yolŋu culture and forming powerful community partnerships, we actively contribute to the evidence base for preventive health in remote Australia. The program serves as a success story, advocating for the effectiveness of community-led initiatives in achieving multifaceted health goals, from improving school attendance and behaviour to promoting healthy lifestyles.

Lessons: The lessons learned highlight the resilience inherent in community-led approaches and advocate for the ongoing imperative of empowering Yolŋu young people for a healthier future. DwM not only addresses immediate health concerns but also becomes an advocate for sustainable, culturally specific preventive health approaches. The conference presentation will share insights into the advocacy and partnership strategies employed, emphasising the broader implications for community-led health interventions and the importance of investing in Indigenous young people.

Keywords: Yolŋu young people, remote health, community-led health, preventive health, cultural pride, empowerment, sustainable interventions.

Problem: Effective communication is fundamental to the provision of and access to safe,
high quality healthcare. At present, ineffective communication between healthcare providers and Indigenous clients is highly prevalent in the Northern Territory. While there is myriad evidence to suggest that individuals are best able to understand and make informed decisions about their health when they can engage with it in their first language, often clients are compelled to navigate discussions with healthcare professionals in English.

What we did: Focused on the imperative for culturally sensitive and in-language resources, Miwatj Health has cultivated a resource development process which centres Yolŋu worldviews and voices throughout, ensuring community engagement, the strengthening of local stakeholder partnerships, and facilitating a collaborative approach that respects and integrates traditional knowledges and perspectives on health.

Results: By actively engaging with fellow stakeholders, we ensure the alignment of developed resources with cultural nuances, linguistic diversity, and community values, fostering a more profound understanding of health information among Yolŋu populations. The session will prompt attendees to consider the way strategic collaborations with key stakeholders can be leveraged to address these hurdles in health communication. Central to this discussion is the integration of Yolŋu knowledge and expertise in leading the development of these resources.

Learnings: This project has demonstrated how the unique insights and cultural understanding of Yolŋu resources contribute to the creation of linguistically accurate and culturally relevant materials. The insights from our work can serve to prepare health teams for a future of improved culturally safe practice and outcomes for their clients.

Keywords: Health communication, collaborative partnerships, in-language resources, Yolŋu communities,

Problem
Aboriginal and Torres Strait Islander people do not feel culturally safe when visiting Echuca Regional Health (ERH). ERH had anecdotal feedback that clients were experiencing discrimination and racism. Many services are over-represented by First Nations people and others have very few attend and that many First Nations community leave the Emergency Department without being seen or against medical advice.

What we did
A co-design approach was undertaken, underpinned by human centered design principles.
We included the voice of the first nations child in the co-design.
The co-design process was conducted from September 2022 to May 2023, noting that strategy refinement and implementation will be ongoing and the formulation of the relevant plans continue beyond May 2023.
The first stage of the process was to conduct scoping surveys. Two surveys were distributed, one for the ERH workforce and the second for the Aboriginal community. Both surveys extensively investigated the recognition, understanding and experience of cultural safety at the organisation, sought to determine whether any racism existed and how it presents.
The second stage, the deep dive, involved interviews, workshops and environmental scans.
It was acknowledged that Aboriginal people must be engaged in a way that is safe, culturally meaningful and authentic, greatly assisted by the support of a number of Aboriginal employees.

Results
Five key themes emerged;
1. Physical Environment
2. Culturally Safe Employment
3. Trust and Visibility
4. Staff Education and Understanding
5. Culturally Safe Services and Programs

Lessons
The co-design process has highlighted that ongoing partnerships with Aboriginal and Torres Strait Islander people when designing services, prevention initiatives and support is essential, to provide opportunity for direct input into the health services and support models and also to ensure services and programs are culturally relevant and cultural safety is considered and prioritised by all staff.
We are committed to increasing our strategies in response to the insights uncovered and are committed to improving the experience of First Nations people at ERH.
The environment of collaboration, respect and authorisation established in the co-design process will continue as we collectively move deeper into implementation.

Sickness and dying in NE Arnhem Land is the harsh reality that sadly confronts Yolŋu families everyday. Health services are overstretched and under resourced whilst program funding comes and goes with limited impact. An Aboriginal community-controlled health organisation, a university and a group of community members are working together in NE Arnhem Land to bring a focus to prevention by empowering local people to engage in and lead an outreach program that brings the clinic to their family home. This outreach approach promotes bicultural learning and education about what is happening to their body as a result of their diet, physical activity level and other lifestyle factors. A key component of the outreach service is to bring the clinic to their home so they may undertake a general health check and point of care testing. This way they can learn from a team of health practitioners and advisers, including community members, in their own language and understand their results instantly and appropriately. This project represents an opportunity to break down the stigma associated with going to the clinic as well as not understanding health issues presented in another language. Aimed at the preventive level, this project seeks to empower the community to lead the way about their health and wellbeing.

Introduction:
The Gippsland Region Public Health Unit (GRPHU) sought to embed self-determination principles within place-based initiatives relevant to the Aboriginal community through an eight-month project (April 2023 - December 2023) funded by the Victorian Department of Health. This comprehensive effort focused on increasing COVID-19 vaccination rates, promote COVID-19 protective behaviours, and continue strengthening relationships between the GRPHU, Aboriginal Community Controlled Health Organisations (ACCHO), and the Aboriginal Community in Gippsland.

What we did:
GRPHU leveraged local insights and knowledge to determine appropriate stakeholders working with local Aboriginal Community and sought advice about the project design. Self-determination principles were embedded within the project scope for flexibility. Enabling participating stakeholders to make choices about activities that would be meaningful for local community.

Results:
The project resulted in successful stakeholder engagement and participation. Seven of the eight stakeholders first consulted participated in the project, designing and implementing a range of COVID-19-related activities tailored to local Aboriginal communities. These activities included but not limited to local events, medical equipment, health promotion resources and innovative COVID-19 vaccination clinic models.
Flexibility within the project scope was identified as an essential and effective way of fostering connections with ACCHO’s and the Aboriginal community. Innovative ideas for activities outside “only COVID-19” focused, provided the opportunity to exchange broader health knowledge for a whole of community approach. Relationships with all participating stakeholders further strengthened with agreed face-to-face meetings to continue after the project completion.

Lessons:
Embedding self-determination principles in project design, preventative health initiatives need to be flexible, reporting that tells a story and reduce the reporting burden is important. Cultural safety is everyone’s business and is a continuous journey, although project may be completed – the work needs to be sustainable.

Conclusion:
By working together, applying the principles of self-determination and closing the gap, our project illustrates a successful model of engaging Aboriginal and Torres Strait Islander organisations in place-based, community-led preventative health actions for COVID-19.