Bone health perspectives among Indigenous people: a qualitative study

Gerontology

Musculoskeletal diseases

Abstract

Objectives: To explore perspectives and beliefs on bone health among Indigenous adults in Victoria.

Design: Qualitative focus groups with semi‐structured questions. Focus group discussions were analysed for themes and subthemes using an Indigenous research framework based on three concepts: Ways of Knowing, Ways of Being and Ways of Doing.

Setting, participants: Focus groups were conducted at Aboriginal Community‐controlled organisations and Community centres. Men and women aged ≥ 35 years who identified as Indigenous and were able to give informed consent were invited to participate.

Results: Eighty‐two Indigenous people participated in twelve focus groups across ten sites in Victoria. Most participants (64) were women, and the majority lived in metropolitan centres, regional centres and large rural towns (Modified Monash categories 1–3). Five themes were developed around the Indigenous framework proposed by Karen Martin‐Booran Mirraboopa — Ways of Knowing, Ways of Doing and Ways of Being — which guided participants in identifying knowledge of exercise for bone and muscle health; connection to Country; importance of regular preventive health activities; food and nutrients as good medicine for bone health; and healthy futures for Community through education. An overarching theme of holistic health, including the aspect of spirituality and related lifestyle factors pertaining to musculoskeletal health, was highlighted.

Conclusion: Increasing bone health awareness by a co‐created Community education program was valued as it would be beneficial for Indigenous people across the life course. To be effective, incorporating traditional Indigenous ways and knowledge along with present‐day health evidence is required.

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1 Monash University, Melbourne, VIC
2 National Centre for Healthy Ageing, Melbourne, VIC
3 University of Melbourne, Melbourne, VIC
4 Victorian Aboriginal Community Controlled Health Organisation, Melbourne, VIC
5 Murrumbidgee Local Health District, Moama, NSW
6 Gariwerd Dreaming, Melbourne, VIC
7 Njernda Aboriginal Corporation, Echuca, VIC
8 Menzies School of Health Research, Charles Darwin University, Darwin, NT
9 Royal Darwin and Palmerston Hospitals NT Health, Darwin, NT
10 Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC
11 Deakin University, Melbourne, VIC
12 Royal Melbourne Hospital, Melbourne, VIC

Correspondence: troy.walker@monash.edu

Open access:

Open access publishing facilitated by Monash University, as part of the Wiley ‐ Monash University agreement via the Council of Australian University Librarians.

Data sharing:

The data for this study will not be shared, as we do not have permission from the participants or ethics approval to do so.

Acknowledgements:

Thank you to all of the Aboriginal and Torres Strait Islander participants who attended the focus groups and the ACCHOs for hosting the focus groups. This study was funded by was funded by a grant from the National Centre for Healthy Ageing (NCHA) through the Commonwealth Government of Australia, for which Ayse Zengin was the lead investigator. Louise Maple‐Brown was supported by a National Health and Medical Research Council Investigator Grant (11194698).

Open access publishing facilitated by Monash University, as part of the Wiley ‐ Monash University agreement via the Council of Australian University Librarians.

Competing interests:

No relevant disclosures.

Received 2 July 2024, accepted 18 December 2024

1. Zengin A, Maple‐Brown LJ, Brennan‐Olsen S, et al. Musculoskeletal health of Indigenous Australians. Arch Osteoporos 2018; 13: 77.
2. Zengin A, Shore‐Lorenti C, Sim M, et al. Why Aboriginal and Torres Strait Islander Australians fall and fracture: the codesigned Study of Indigenous Muscle and Bone Ageing (SIMBA) protocol. BMJ Open 2022; 12(4): e056589.
3. Australian Institute of Health and Welfare. The problem of osteoporotic hip fracture in Australia (AIHW Bulletin No. 76; Cat. No. AUS 121). Canberra: AIHW, 2010. https://www.aihw.gov.au/getmedia/ea96bc4d‐0b97‐4c5a‐b792‐08b343752adc/10695.pdf?v=20230605152944&inline=true (viewed Aug 2024).
4. Wong YY, Flicker L, Draper G, et al. Hip fractures among Indigenous Western Australians from 1999 to 2009. Intern Med J 2013; 43: 1287‐1292.
5. Bliuc D, Alarkawi D, Nguyen TV, et al. Risk of subsequent fractures and mortality in elderly women and men with fragility fractures with and without osteoporotic bone density: the Dubbo osteoporosis epidemiology study. J Bone Miner Res 2015; 30: 637‐646.
6. Holloway K, Brennan S, Kotowicz M, et al. Prior fracture as a risk factor for future fracture in an Australian cohort. Osteoporos Int 2015; 26: 629‐635.
7. Huria T, Palmer SC, Pitama S, et al. Consolidated criteria for strengthening reporting of health research involving Indigenous peoples: the CONSIDER statement. BMC Med Res Methodol 2019; 19: 173.
8. Australian Indigenous HealthInfoNet. The Australian Indigenous HealthInfoNet guidelines for Aboriginal and Torres Strait Islander terminology. https://healthinfonet.ecu.edu.au/healthinfonet/getContent.php?linkid=675466&title=The+Australian+Indigenous+HealthInfoNet+guidelines+for+Aboriginal+and+Torres+Strait+Islander+terminology&contentid=44676_1 (viewed June 2025).
9. Bessarab D, Ng’andu B Yarning about yarning as a legitimate method in Indigenous research. Int J Crit Indig Stud 2010; 3: 37‐50.
10. Barlo S, Boyd WE, Pelizzon A, Wilson S. Yarning as protected space: principles and protocols. AlterNative 2020; 16: 90‐98.
11. Walker M, Fredericks B, Mills K, Anderson D. “Yarning” as a method for community‐based health research with Indigenous women: the Indigenous women's wellness research program. Health Care Women Int 2014; 35: 1216‐1226.
12. Dudgeon P, Milroy H, Selkirk B, et al. Decolonisation, Indigenous health research and Indigenous authorship: sharing our teams' principles and practices. Med J Aust 2024; 221: 578‐586. https://www.mja.com.au/journal/2024/221/11/decolonisation‐indigenous‐health‐research‐and‐indigenous‐authorship‐sharing‐our
13. Demontiero O, Vidal C, Duque G. Aging and bone loss: new insights for the clinician. Ther Adv Musculoskelet Dis 2012; 4: 61‐76.
14. Martin K. Ways of knowing, being and doing: a theoretical framework and methods for Indigenous and Indigenist research. J Aust Stud 2003; 27: 203‐214.
15. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3: 77‐101.
16. National Health and Medical Research Council, Australian Research Council, Universities Australia. National statement on ethical conduct in human research 2007 (updated 2018). Canberra: Commonwealth of Australia, 2018. https://www.nhmrc.gov.au/about‐us/publications/national‐statement‐ethical‐conduct‐human‐research‐2007‐updated‐2018 (viewed Aug 2024).
17. National Health and Medical Research Council. Keeping research on track II. A companion document to Ethical conduct in research with Aboriginal and Torres Strait Islander peoples and communities: guidelines for researchers and stakeholders. Canberra: Commonwealth of Australia, 2018. https://www.nhmrc.gov.au/sites/default/files/documents/Indigenous%20guidelines/Keeping‐research‐on‐track.pdf (viewed Aug 2024).
18. Australian Institute of Aboriginal and Torres Strait Islander Studies. AIATSIS Code of Ethics for Aboriginal and Torres Strait Islander Research. Canberra: AIATSIS, 2020. https://aiatsis.gov.au/sites/default/files/2020‐10/aiatsis‐code‐ethics.pdf (viewed Aug 2024).
19. National Health and Medical Research Council. Ethical conduct in research with Aboriginal and Torres Strait Islander peoples and communities: guidelines for researchers and stakeholders. Canberra: Commonwealth of Australia, 2018. https://www.nhmrc.gov.au/about‐us/resources/ethical‐conduct‐research‐aboriginal‐and‐torres‐strait‐islander‐peoples‐and‐communities (viewed Aug 2024).
20. Samsudin N, Ooi FK, Chen CK. Bone health status, muscular strength and power, and aerobic and anaerobic capacities of Malaysian male athletes involved in sports with different mechanical loading on bones. Malays J Med Sci 2022; 29: 54‐67.
21. Warden SJ, Sventeckis AM, Surowiec RK, Fuchs RK. Enhanced bone size, microarchitecture, and strength in female runners with a history of playing multidirectional sports. Med Sci Sports Exerc 2022; 54: 2020‐2030.
22. Allen B, Canuto K, Evans JR, et al. Facilitators and barriers to physical activity and sport participation experienced by Aboriginal and Torres Strait Islander adults: a mixed method review. Int J Environ Res Public Health 2021; 18: 9893.
23. Dahlberg EE, Hamilton SJ, Hamid F, Thompson SC. Indigenous Australians perceptions’ of physical activity: a qualitative systematic review. Int J Environ Res Public Health 2018; 15: 1492.
24. Strong J, Nielsen M, Williams M, et al. Quiet about pain: experiences of Aboriginal people in two rural communities. Aust J Rural Health 2015; 23: 181‐184.
25. Macniven R, Simon A, Wilson R, et al. Ironbark: developing a healthy community program for older Aboriginal people. Health Promot J Austr 2022; 33 Suppl 1: 128‐133.
26. Lukaszyk C, Coombers J, Sherrington C, et al. The Ironbark program: implementation and impact of a community‐based fall prevention pilot program for older Aboriginal and Torres Strait Islander people. Health Promot J Austr 2018; 29: 189‐198.
27. Canuto KJ, McDermott RA, Cargo M, Esterman AJ. Study protocol: a pragmatic randomised controlled trial of a 12‐week physical activity and nutritional education program for overweight Aboriginal and Torres Strait Islander women. BMC Public Health 2011; 11: 655.
28. Canuto KJ, Spagnoletti B, McDermott RA, Cargo M. Factors influencing attendance in a structured physical activity program for Aboriginal and Torres Strait Islander women in an urban setting: a mixed methods process evaluation. Int J Equity Health 2013; 12: 11.
29. Schembri L, Curran J, Collins L, et al. The effect of nutrition education on nutrition‐related health outcomes of Aboriginal and Torres Strait Islander people: a systematic review. Aust N Z J Public Health 2016; 40 Suppl 1: S42‐S47.
30. Christidis R, Lock M, Walker T, et al. Concerns and priorities of Aboriginal and Torres Strait Islander peoples regarding food and nutrition: a systematic review of qualitative evidence. Int J Equity Health 2021; 20: 220.
31. Nilson C, Kearing‐Salmon KA, Morrison P, Fetherston C. An ethnographic action research study to investigate the experiences of Bindjareb women participating in the cooking and nutrition component of an Aboriginal health promotion programme in regional Western Australia. Public Health Nutr 2015; 18: 3394‐3405.
32. Mellor D, McCabe M, Ricciardelli L, et al. Toward an understanding of the poor health status of Indigenous Australian men. Qual Health Res 2016; 26: 1949‐1960.
33. Colles SL, Maypilama E, Brimblecombe J. Food, food choice and nutrition promotion in a remote Australian Aboriginal community. Aust J Prim Health 2014; 20: 365‐372.
34. Thorpe S, Browne J. Closing the nutrition and physical activity gap in Victoria: Victorian Aboriginal nutrition and physical activity strategy. Melbourne: Victorian Aboriginal Community Controlled Health Organisation, 2009. https://apo.org.au/sites/default/files/resource‐files/2009‐09/apo‐nid18988.pdf (viewed Aug 2024).
35. Browne J, Lock M, Walker T, et al. Effects of food policy actions on Indigenous peoples’ nutrition‐related outcomes: a systematic review. BMJ Glob Health 2020; 5: e002442.
36. Browne J, Walker T, Hill K, et al. Food policies for Aboriginal and Torres Strait Islander health (FoodPATH): community report. Melbourne: Deakin University and Victorian Aboriginal Community Controlled Health Organisation, 2023. https://cdn.intelligencebank.com/au/share/NJA21J/a7eD7/oGBNL/original/FoodPATH+Community+Report (viewed Aug 2024).
37. Fatima Y, Liu Y, Cleary A, et al. Connecting the health of country with the health of people: application of “caring for country” in improving the social and emotional well‐being of Indigenous people in Australia and New Zealand. Lancet Reg Health West Pac 2023; 31: 100648.
38. Davy C, Harfield S, McArthur A, et al. Access to primary health care services for Indigenous peoples: a framework synthesis. Int J Equity Health 2016; 15: 163.
39. Aspin C, Brown N, Jowsey T, et al. Strategic approaches to enhanced health service delivery for Aboriginal and Torres Strait Islander people with chronic illness: a qualitative study. BMC Health Serv Res 2012; 12: 143.

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Research

Am I on the list? Clinician‐reported factors for kidney transplantation non‐waitlisting among Aboriginal and Torres Strait Islander people with kidney failure: a cross‐sectional study

Stephen P McDonald AM, Katie Cundale, Christopher E Davies, Kelli Karrikarringka Owen (Kaurna, Nharangga, and Ngarrindjeri), Kerry Dole, Feruza Kholmurodova, Matilda D’Antoine (Paakantyi) and Jaquelyne T Hughes (Wagadagam)

Med J Aust 2025; 223 (1): . || doi: 10.5694/mja2.52698
Published online: 7 July 2025

Topics

Urologic diseases

Surgical procedures, operative

Abstract

Objectives: To describe clinician‐reported reasons for non‐waitlisting of patients with kidney failure for deceased donor kidney transplantation, and to examine disparities affecting Aboriginal and Torres Strait Islander people.

Design: Retrospective cross‐sectional analysis of data from a national clinical quality registry.

Participants and setting: Patients receiving dialysis in 26 Australian renal units as of 31 December 2020.

Main outcome measures: Rates of active waitlisting for kidney transplantation and clinician‐reported reasons for non‐waitlisting.

Results: Thirty‐six of 1832 Aboriginal and Torres Strait Islander people (2.0%) were actively waitlisted, compared with 512 of 6128 non‐Indigenous people (8.4%). For Aboriginal and Torres Strait Islander patients aged < 65 years, 457 of 1204 (38%) were not waitlisted due to a permanent contraindication, 276 (23%) due to a temporary contraindication, and 232 (19%) due to incomplete work‐up. Among those with a contraindication, cardiovascular disease was reported as the reason for about a quarter of people in both groups. Obesity was cited for 163 Aboriginal and Torres Strait Islander patients aged < 65 years (22%) and 30 Aboriginal and Torres Strait Islander patients aged ≥ 65 years (10%); in the non‐Indigenous group, obesity was cited for 207 (26%) and 163 (9%) patients aged < 65 years and ≥ 65 years, respectively. Cancer was reported for 28 Aboriginal and Torres Strait Islander patients aged < 65 years (4%) and 86 non‐Indigenous patients aged < 65 years (11%). Other reasons for non‐waitlisting, reported as free text, included patient safety, smoking, age and mental health.

Conclusions: Aboriginal and Torres Strait Islander people experience inequities in waitlisting for kidney transplantation across multiple stages of a complex process. Addressing these barriers requires system‐level reform and accountability to improve equity in transplantation access.

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1 Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA
2 Adelaide EpiCentre, Adelaide, SA
3 National Indigenous Kidney Transplantation Taskforce, Adelaide, SA
4 University of Adelaide, Adelaide, SA
5 AKction Reference Group, Adelaide, SA
6 Northern Territory Department of Health, Alice Springs, NT
7 Flinders University, Darwin, NT
8 Royal Darwin Hospital, Darwin, NT

Correspondence: stephenm@anzdata.org.au

Open access:

Open access publishing facilitated by The University of Adelaide, as part of the Wiley – The University of Adelaide agreement via the Council of Australian University Librarians.

Data Sharing:

ANZDATA has established policies for access to various types of data (including those underlying this manuscript). These policies and associated application procedures are available at https://www.anzdata.org.au/anzdata/data‐requests/request‐procedure.

Acknowledgements:

The National Indigenous Kidney Transplantation Taskforce is funded by a grant from the Australian Government Department of Health and Aged Care (4‐BIA3J8Y) that is held by the Transplantation Society of Australia and New Zealand. The Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) receives funding from the Australian Organ and Tissue Authority to support its core operations. Neither body had a role in study design, data collection, data analysis or interpretation of findings. The authors recognise Indigenous peoples research leadership and their knowledges contained within the following cited references: 1,2,8,11,12,18,19,20,31,32 and 34,35,36.

Competing interests:

Jaquelyne Hughes is a Guest Editor for the 2025 NAIDOC Week MJA Special Issue and was not involved in any editorial decision making about this article.

Author contributions:

McDonald SP: Conceptualization; formal analysis; methodology; supervision; writing – original draft; writing – review and editing. Cundale K: Formal analysis; project administration; writing – original draft; writing – review and editing. Davies C: Data curation; formal analysis; visualization; writing – original draft; writing – review and editing. Owen K: Conceptualization; writing – review and editing. Dole K: Conceptualization; supervision; writing – review and editing. Kholmurodova F: Data curation; formal analysis; visualization. D’Antoine M: Project administration; writing – review and editing. Hughes JT: Conceptualization; methodology; supervision; writing – original draft; writing – review and editing. All authors have reviewed and approved the final manuscript and agree to be accountable for their contributions.

1. Bateman S, Solomon B, Davies C, et al. Chapter 10: Kidney failure in Aboriginal and Torres Strait Islander Australians. In: Australia and New Zealand Dialysis and Transplant Registry 46th annual report. Adelaide: ANZDATA, 2023. https://www.anzdata.org.au/wp‐content/uploads/2023/09/ANZDATA_AR‐2022‐23_Chapter‐10_F2.pdf (viewed Sept 2024).
2. Bateman S, Owen K, Lester R, et al. The survival benefit of deceased donor kidney transplantation for Aboriginal and Torres Strait Islander people, 2006–20: a retrospective national cohort study. Med J Aust 2024; 221: 111‐116. https://www.mja.com.au/journal/2024/221/2/survival‐benefit‐deceased‐donor‐kidney‐transplantation‐aboriginal‐and‐torres
3. Wyld ML, Wyburn KR, Chadban SJ. Global perspective on kidney transplantation: Australia. Kidney360 2021; 2: 1641‐1644.
4. Transplantation Society of Australia and New Zealand. Clinical guidelines for organ transplantation from deceased donors, version 1.1. Canberra: TSANZ, 2017.
5. Khanal N, Lawton PD, Cass A, McDonald SP. Disparity of access to kidney transplantation by Indigenous and non‐Indigenous Australians. Med J Aust 2018; 209: 261‐266. https://www.mja.com.au/journal/2018/209/6/disparity‐access‐kidney‐transplantation‐indigenous‐and‐non‐indigenous
6. Goodman D, Atkinson A. Self empowerment of Indigenous Australians with renal failure to ask their doctors “Am I on the kidney transplant waiting list?” [abstract]. Australian and New Zealand Society of Nephrology Annual Scientific Meeting; Sydney (hybrid), 17–19 Oct 2022. https://anzsnevents.com/15664 (viewed Sept 2024).
7. Vanholder R, Annemans L, Braks M, et al. Inequities in kidney health and kidney care. Nat Rev Nephrol 2023; 19: 694‐708.
8. Hughes JT, Dembski L, Kerrigan V, et al. Gathering perspectives—finding solutions for chronic and end‐stage kidney disease: Indigenous patient voices. Nephrology (Carlton) 2021; 26: 215‐223.
9. Tiong MK, Thomas S, Fernandes DK, Cherian S. Examining barriers to timely waitlisting for kidney transplantation for Indigenous Australians in Central Australia. Intern Med J 2022; 52: 288‐294.
10. Garrard E, McDonald SP. Improving access to and outcomes of kidney transplantation for Aboriginal and Torres Strait Islander people in Australia: performance report. Sydney: Transplantation Society of Australia and New Zealand, 2019. https://tsanz.com.au/storage/NIKTT/TSANZ‐Performance‐Report‐‐‐Improving‐Indigenous‐Transplant‐Outcomes‐Final‐edited‐1.pdf (viewed Sept 2024).
11. Cundale K, Hughes JT, Owen K, McDonald SP. Final report: National Indigenous Kidney Transplantation Taskforce. Adelaide: NIKTT, 2023. https://www.niktt.com.au/finalreport (viewed Sept 2024).
12. Lee D, Davies C, Au E, et al. Chapter 6: Australian transplant waiting list. In: Australia and New Zealand Dialysis and Transplant Registry 47th annual report. Adelaide: ANZDATA, 2024. https://www.anzdata.org.au/wp‐content/uploads/2024/12/06_waiting_list_2023_ar_2024_chapter_F_20241224.pdf (viewed Nov 2024).
13. Von Elm E Altman D, Egger M, et al. STROBE Initiative. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370: 1453‐1457.
14. Australia and New Zealand Dialysis and Transplant Registry. Data collection. Adelaide: ANZDATA, 2023. https://www.anzdata.org.au/anzdata/services/data‐management/data‐collection (viewed Sept 2024).
15. Australia and New Zealand Dialysis and Transplant Registry. Transplant Assessment Stage [form TA]. Adelaide: ANZDATA, 2019. https://www.anzdata.org.au/wp‐content/uploads/2020/01/TxAssessmentStage_TA.pdf (viewed Sept 2024).
16. Huria T, Palmer SC, Pitama S, et al. Consolidated criteria for strengthening the reporting of health research involving Indigenous peoples: the CONSIDER statement. BMC Med Res Methodol 2019; 19: 173.
17. Australia and New Zealand Dialysis and Transplant Registry. Data requests relating to patient ethnicity. Adelaide: ANZDATA, 2021. https://www.anzdata.org.au/wp‐content/uploads/2021/12/ANZDATA_update_on_data_requests_related_to_patient_ethnicity.pdf (viewed Sept 2024).
18. Bateman S, Riceman M, Owen K, et al. Models of care to address disparities in kidney health outcomes for First Nations people. Kidney Int 2023; 104: 681‐689.
19. Hughes J, Kirkham R, Min OA, et al. Patient‐identified health service transformation: an Aboriginal patient's experience with extensive chronic tinea corporis and delayed kidney transplantation wait‐listing. Ren Soc Australas J 2019; 15: 92‐96.
20. Naidu P, Paolucci O, Luta R, Hughes JT. Optimisation during transition to dialysis commencement. Med J Aust 2024; 221: 18‐24. https://www.mja.com.au/journal/2024/221/1/optimisation‐during‐transition‐dialysis‐commencement
21. Mehrabi A, Fonouni H, Wente M, et al. Wound complications following kidney and liver transplantation. Clin Transplant 2006; 20: 97‐110.
22. Nicoletto BB, Fonseca NKO, Manfro RC, et al. Effects of obesity on kidney transplantation outcomes: a systematic review and meta‐analysis. Transplantation 2014; 98: 167‐176.
23. Hill CJ, Courtney AE, Cardwell CR, et al. Recipient obesity and outcomes after kidney transplantation: a systematic review and meta‐analysis. Nephrol Dial Transplant 2015; 30: 1403‐1411.
24. Sood A, Hakim DN, Hakim NS. Consequences of recipient obesity on postoperative outcomes in a renal transplant: a systematic review and meta‐analysis. Exp Clin Transplant 2016; 14: 121‐128.
25. Lafranca JA, IJzermans JNM, Betjes MG, et al. Body mass index and outcome in renal transplant recipients: a systematic review and meta‐analysis. BMC Med 2015; 13: 111.
26. Gioco R, Sanfilippo C, Veroux P, et al. Abdominal wall complications after kidney transplantation: a clinical review. Clin Transplant 2021; 35: e14506.
27. Boan P, Swaminathan R, Irish A. Infectious complications in Indigenous renal transplant recipients in Western Australia. Intern Med J 2017; 47: 648‐655.
28. Power T, East L, Gao Y, et al. A mixed‐methods evaluation of an urban Aboriginal diabetes lifestyle program. Aust N Z J Public Health 2021; 45: 143‐149.
29. Grunseit AC, Bohn‐Goldbaum E, Crane M, et al. Participant profile and impacts of an Aboriginal healthy lifestyle and weight loss challenge over four years 2012–2015. Aust N Z J Public Health 2019; 43: 328‐333.
30. Sushames A, Engelberg T, Gebel K. Perceived barriers and enablers to participation in a community‐tailored physical activity program with Indigenous Australians in a regional and rural setting: a qualitative study. Int J Equity Health 2017; 16: 172.
31. Chaturvedi S, Ullah S, Hughes JT. Kidney transplantation access and outcomes for Aboriginal and Torres Strait Islander children and young adults, 1963–2020: an ANZDATA registry study. Med J Aust 2024; 221: 47‐54. https://www.mja.com.au/journal/2024/221/1/kidney‐transplantation‐access‐and‐outcomes‐aboriginal‐and‐torres‐strait‐islander
32. Saunders P. Fulfilling cultural safety expectations in specialist medical education and training: considerations for colleges to advance recognition and quality. Med J Aust 2024; 221: 8‐12. https://www.mja.com.au/journal/2024/221/1/fulfilling‐cultural‐safety‐expectations‐specialist‐medical‐education‐and
33. Medical Board of Australia. Cultural safety education requirements for specialist registration. Melbourne: Australian Health Practitioner Regulation Agency, 2024. https://www.medicalboard.gov.au/Registration/Types/Specialist‐Registration/Cultural‐safety‐education‐requirements.aspx (viewed Apr 2025).
34. Hughes JT, Cundale K, Webster A, et al. Towards equity in kidney transplantation: the next steps. Med J Aust 2023; 219(8 Suppl): S19‐S22. https://www.mja.com.au/journal/2023/219/8/towards‐equity‐kidney‐transplantation‐next‐steps
35. Ryder C, Hossain S, Howard L, et al. Indigenous governance, ethics, and data collection in Australian clinical registries. Med J Aust 2024; 221: 156‐161. https://www.mja.com.au/journal/2024/221/3/indigenous‐governance‐ethics‐and‐data‐collection‐australian‐clinical‐registries
36. Tunnicliffe DJ, Bateman S, Arnold‐Chamney M, et al. Recommendations for culturally safe clinical kidney care for First Nations Australians: a guideline summary. Med J Aust 2023; 219: 374‐385. https://www.mja.com.au/journal/2023/219/8/recommendations‐culturally‐safe‐clinical‐kidney‐care‐first‐nations‐australians
37. Australian Health Practitioner Regulation Agency. National Law amendments. Melbourne: AHPRA, 2024. https://www.ahpra.gov.au/About‐Ahpra/Ministerial‐Directives‐and‐Communiques/National‐Law‐amendments (viewed Dec 2024).

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Research

What do Aboriginal people in the Northern Territory value during the operation journey? A qualitative study

Edith B Waugh, Marita Hefler, Sophie Pascoe, Mark Mayo, Matthew JL Hare, David A Story, Neil Wilkshire, Peter Henwood, David Croker and Jampijinpa Ross

Med J Aust 2025; 223 (1): . || doi: 10.5694/mja2.52695
Published online: 7 July 2025

Topics

Statistics, epidemiology and research design

Global health

Information science

Otorhinolaryngologic diseases

Abstract

Objective: To explore the values of Aboriginal people in the Northern Territory during their perioperative journey.

Design: A community‐based participatory action research approach was used, integrating yarning, deep listening and reflection methods to gather qualitative data in culturally appropriate ways. Data collection involved two yarning circles followed by interpretation and triangulation sessions with co‐researchers.

Setting: Conducted in non‐health care settings in Garramilla (Darwin) between May 2023 and September 2024, the study included participants from urban, regional and remote NT Aboriginal communities.

Participants: Purposive and snowball sampling were used to engage 18 participants with lived experience of surgery, who share expertise in renal health journeys and have kinship ties spanning from Saltwater Country to Desert Country, with diverse age, language and gender representation.

Main outcome measures: Thematic insights into what First Nations peoples in the NT value during the perioperative journey, to inform culturally safe models of care.

Results: Respect emerged as the core principle in the perioperative journey, with family involvement, cultural practices and effective communication identified as key elements. Respect was evident in honouring cultural protocols, integrating traditional healing practices and recognising patient autonomy. Family involvement was highlighted as essential, with kinship ties influencing shared decision‐making processes and support throughout the perioperative experience. Culturally competent communication, including the use of interpreters and clear explanations, played a critical role in bridging cultural differences and ensuring shared understanding. Together, these elements fostered a sense of safety, belonging and empowerment. Ultimately, trust was identified as an overarching outcome that unified these interconnected values, enhancing patient comfort, engagement and overall satisfaction in the perioperative journey.

Conclusion: Respect is integral to Aboriginal people in the perioperative journey, and they value family, culture and communication when navigating surgery. When these values coalesce, trust is generated. These findings highlight the need to integrate culturally informed, patient‐centred care models that prioritise respect and trust building to improve accessibility, experience and surgical outcomes.

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1 Menzies School of Health Research, Charles Darwin University, Darwin, NT
2 Royal Darwin Hospital, Tiwi, NT
3 University of Melbourne, Melbourne, VIC
4 Flinders University, Darwin, NT
5 Austin Health, Melbourne, VIC
6 Purple House, Alice Springs, NT

Correspondence: edith.waugh@menzies.edu.au

Open access:

Open access publishing facilitated by Charles Darwin University, as part of the Wiley – Charles Darwin University agreement via the Council of Australian University Librarians.

Data Sharing:

Data collected and analysed during the study are not publicly available due to privacy issues and ethical considerations. Data may be available from the corresponding author on reasonable request.

Acknowledgements:

Warning: Aboriginal and Torres Strait Islander readers are advised that this article captures the knowledge and lived experiences of Indigenous people who have passed. With permission from family, we refer to our senior co‐author as “Jampijinpa” Ross. This article is a testament to his contributions to First Nations health. Out of cultural sensitivity, we do not use the names nor images of Indigenous people who participated in this research who have subsequently passed away.

Edith Waugh received an ANZCA Foundation (Australian and New Zealand College of Anaesthetists) Health Equity Grant 2022. The funding allowed planning, coordination and completion of focus (yarning) groups; participation and sharing of First Nations knowledge was appropriately reimbursed. Edith Waugh is supported by an Australian Government Research Training Scholarship. Matthew Hare is supported by the National Health and Medical Research Council (grant number 1194698), the Sylvia and Charles Viertel Foundation and an Australian Diabetes Society Skip Martin Fellowship.

The Top End Indigenous Reference Group and research assistant Stephanie Long from the INFERR (INtravenous iron polymaltose for First Nations Australian patients with high FERRitin levels on hemodialysis) study at Menzies School of Health Research were the catalysts leading to this study. This study emerged in response to their feedback about exploring postoperative outcomes for First Nations people in the Northern Territory and the need for this research to incorporate patient values.

Competing interests:

No relevant disclosures.

Author contributions:

Waugh EB: Conceptualization; methodology; investigation (data collection); formal analysis; writing – original draft; writing – review and editing; project administration; funding acquisition. Hefler M: Methodology; formal analysis; writing – review and editing; supervision. Pascoe S: Methodology; investigation (data collection); formal analysis; writing – review and editing; project administration. Mayo M: Conceptualization; writing – review and editing; supervision. Hare MJL: Writing – review and editing; supervision. Story DA: Writing – review and editing; funding acquisition, supervision. Wilkshire N: Writing – methodology; investigation (data collection); formal analysis; review and editing; supervision. Henwood P: Writing – methodology; investigation (data collection); formal analysis; review and editing; supervision. Croker D: Writing – methodology; investigation (data collection); formal analysis; review and editing; supervision. Ross J: Writing – methodology; investigation (data collection); formal analysis; review and editing; supervision.

1. Koea J, Ronald M. What do Indigenous communities want from their surgeons and surgical services: a systematic review. Surgery 2020; 167: 661‐667.
2. O’Brien P, Bunzli S, Lin I, et al. Addressing surgical inequity for Aboriginal and Torres Strait Islander people in Australia's universal health care system: a call to action. ANZ J Surg 2021; 91: 238‐244.
3. Meara JG, Leather AJ, Hagander L, et al. Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 2015; 386: 569‐624.
4. Australian Institute of Health and Welfare. Module 3: Access to health care services. In: Cultural safety in health care for Indigenous Australians: monitoring framework. Canberra: AIHW, 2023. https://www.aihw.gov.au/reports/indigenous‐australians/cultural‐safety‐health‐care‐framework/contents/module‐3‐access‐to‐health‐care‐services (viewed Sept 2024).
5. Australian Institute of Health and Welfare. Australian hospital statistics 2012–13 [Cat. No. HSE 145]. Canberra: AIHW, 2014. https://www.aihw.gov.au/reports/hospitals/australian‐hospital‐statistics‐2012‐13/summary (viewed May 2025).
6. Australian Institute of Health and Welfare, National Indigenous Australians Agency. 3.14: Access to services compared with need. In: Aboriginal and Torres Strait Islander Health Performance Framework. Canberra: AIHW, National Indigenous Australians Agency, 2023. https://www.indigenoushpf.gov.au/measures/3‐14‐access‐to‐services‐compared‐with‐need (viewed Sept 2024).
7. Australian Bureau of Statistics. Northern Territory: Aboriginal and Torres Strait Islander population summary. Canberra: ABS, 2022. https://www.abs.gov.au/articles/northern‐territory‐aboriginal‐and‐torres‐strait‐islander‐population‐summary (viewed Sept 2024).
8. Northern Territory Government. Aboriginal languages in NT. Darwin: Northern Territory Government, 2022. https://nt.gov.au/community/interpreting‐and‐translating‐services/aboriginal‐interpreter‐service/aboriginal‐languages‐in‐nt (viewed Sept 2024).
9. Australian Institute of Health and Welfare. Health and wellbeing of First Nations people. Canberra: AIHW, 2024. https://www.aihw.gov.au/reports/australias‐health/indigenous‐health‐and‐wellbeing (viewed Sept 2024).
10. Hughes J, Freeman N, Beaton B, et al. My experiences with kidney care: a qualitative study of adults in the Northern Territory of Australia living with chronic kidney disease, dialysis and transplantation. PLoS One 2019; 14: e0225722.
11. Wade V, Stewart M. Bridging the gap between science and Indigenous cosmologies: rheumatic heart disease Champions4Change. Microbiol Aust 2022; 43: 89‐92.
12. Binks P, Ross C, Gurruwiwi GG, et al. Adapting and translating the ‘Hep B Story’ app the right way: a transferable toolkit to develop health resources with, and for, Aboriginal people. Health Promot J Austr 2024; 35: 1244‐1254.
13. Kerrigan V, McGrath SY, Majoni SW, et al. “The talking bit of medicine, that's the most important bit”: doctors and Aboriginal interpreters collaborate to transform culturally competent hospital care. Int J Equity Health 2021; 20: 170.
14. Kerrigan V, Lewis N, Cass A, et al. “How can I do more?”: cultural awareness training for hospital‐based healthcare providers working with high Aboriginal caseload. BMC Med Educ 2020; 20: 173.
15. Kerrigan V, McGrath SY, Baker RD, et al. “If they help us, we can help them”: First Nations peoples identify intercultural health communication problems and solutions in hospital in Northern Australia. J Racial Ethn Health Disparities 2024; https://doi.org/10.1007/s40615‐024‐02160‐4 [Epub ahead of print].
16. Artuso S, Cargo M, Brown A, Daniel M. Factors influencing health care utilisation among Aboriginal cardiac patients in Central Australia: a qualitative study. BMC Health Serv Res 2013; 13: 83.
17. Waugh E, Mayo M, Hefler M. Grant focuses on First Nations people. ANZCA Bull 2022; 31: 42‐44.
18. Martin K. Ways of knowing, being and doing: a theoretical framework and methods for Indigenous and Indigenist research. J Aust Stud 2003; 27: 203‐214.
19. Dudgeon P, Bray A, Darlaston‐Jones D, Walker R. Aboriginal participatory action research: an Indigenous research methodology strengthening decolonisation and social and emotional wellbeing [discussion paper and literature review]. Melbourne: Lowitja Institute, 2020. https://www.lowitja.org.au/wp‐content/uploads/2023/05/LI_Discussion_Paper_P‐Dudgeon_FINAL3.pdf (viewed Apr 2025).
20. Sharmil H, Kelly J, Bowden M, et al. Participatory action research–Dadirri–Ganma, using yarning: methodology co‐design with Aboriginal community members. Int J Equity Health 2021; 20: 160.
21. Bessarab D, Ng’andu B. Yarning about yarning as a legitimate method in Indigenous research. Int J Crit Indig Stud 2010; 3: 37‐50.
22. Ungunmerr‐Baumann MR, Groom RA, Schuberg EL, et al. Dadirri: an Indigenous place‐based research methodology. AlterNative 2022; 18: 94‐103.
23. Pascoe S, Croker C, Ross L, et al. The role of Aboriginal kidney health mentors in the transplant journey: a qualitative evaluation. Health Promot J Austr 2025; 36: e70000.
24. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32‐item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19: 349‐357.
25. Harfield S, Pearson O, Morey K, et al. Assessing the quality of health research from an Indigenous perspective: the Aboriginal and Torres Strait Islander quality appraisal tool. BMC Med Res Methodol 2020; 20: 79.
26. Huria T, Palmer SC, Pitama S, et al. Consolidated criteria for strengthening the reporting of health research involving Indigenous peoples: the CONSIDER statement. BMC Med Res Methodol 2019; 19: 173.
27. Long S, Ross C, Koops J, et al. Engagement and partnership with consumers and communities in the co‐design and conduct of research: lessons from the INtravenous iron polymaltose for First Nations Australian patients with high FERRitin levels on haemodialysis (INFERR) clinical trial. Res Involv Engagem 2024; 10: 73.
28. Australian Health Practitioner Regulation Agency. National Law amendments. Melbourne: AHPRA, 2024. https://www.ahpra.gov.au/About‐Ahpra/Ministerial‐Directives‐and‐Communiques/National‐Law‐amendments (viewed Apr 2025).
29. Garvey G, Anderson K, Gall A, et al. The fabric of Aboriginal and Torres Strait Islander wellbeing: a conceptual model. Int J Environ Res Public Health 2021; 18: 7745.
30. Australian and New Zealand College of Anaesthetists. A framework for perioperative care in Australia and New Zealand. Melbourne: ANZCA, 2021. https://www.anzca.edu.au/getContentAsset/6959c2b4‐64dc‐4e7f‐8341‐8f74b72f1a14/80feb437‐d24d‐46b8‐a858‐4a2a28b9b970/The‐Perioperative‐Care‐Framework‐document.pdf (viewed May 2025).
31. Amery R. Recognising the communication gap in Indigenous health care. Med J Aust 2017; 207: 13‐15. https://www.mja.com.au/journal/2017/207/1/recognising‐communication‐gap‐indigenous‐health‐care
32. Ralph AP, Lowell A, Murphy J, et al. Low uptake of Aboriginal interpreters in healthcare: exploration of current use in Australia's Northern Territory. BMC Health Serv Res 2017; 17: 733.
33. Kerrigan V, McGrath SY, Majoni SW, et al. From “stuck” to satisfied: Aboriginal people's experience of culturally safe care with interpreters in a Northern Territory hospital. BMC Health Serv Res 2021; 21: 548.
34. Lawrence M, Dodd Z, Mohor S, et al. Improving the patient journey: achieving positive outcomes for remote Aboriginal cardiac patients. Darwin: Cooperative Research Centre for Aboriginal Health, 2009. https://www.lowitja.org.au/wp‐content/uploads/2023/05/Improving_the_patient_journey.pdf (viewed Apr 2025).
35. Jongen C, McCalman J, Bainbridge R, Clifford A. Health workforce development interventions to improve cultural competence. In: Cultural competence in health: a review of the evidence. Singapore: Springer, 2017; pp. 49‐64.
36. Kingsley J, Townsend M, Henderson‐Wilson C, Bolam B. Developing an exploratory framework linking Australian Aboriginal peoples’ connection to Country and concepts of wellbeing. Int J Environ Res Public Health 2013; 10: 678‐698.
37. Kairuz CA, Casanelia LM, Bennett‐Brook K, et al. Impact of racism and discrimination on physical and mental health among Aboriginal and Torres Strait Islander peoples living in Australia: a systematic scoping review. BMC Public Health 2021; 21: 1302.
38. Gatwiri K, Rotumah D, Rix E. BlackLivesMatter in healthcare: racism and implications for health inequity among Aboriginal and Torres Strait Islander peoples in Australia. Int J Environ Res Public Health 2021; 18: 4399.
39. Taylor K, Guerin P. Health care and Indigenous Australians: cultural safety in practice. 2nd ed. Melbourne: Palgrave Macmillan, 2014.
40. Durey A, Thompson SC. Reducing the health disparities of Indigenous Australians: time to change focus. BMC Health Serv Res 2012; 12: 151.
41. Bond CJ, Singh D. More than a refresh required for closing the gap of Indigenous health inequality. Med J Aust 2020; 212: 198‐199.e1. https://www.mja.com.au/journal/2020/212/5/more‐refresh‐required‐closing‐gap‐indigenous‐health‐inequality

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Perspective

Climate and environmental crisis: effects on ear and hearing health in Australia and for Aboriginal and Torres Strait Islander peoples

Georgia M Tongs (Wiradjuri), Isabella Ludbrook, Jennifer H Martin, Robert Eisenberg and Kelvin M Kong (Worimi)

Med J Aust 2025; 223 (1): . || doi: 10.5694/mja2.52689
Published online: 7 July 2025

Topics

As a collaborative research team, we acknowledge the diverse perspectives, lived experiences, and cultural knowledges that shape our work. We are united in our commitment to examining health and climate through the lens of Aboriginal and Torres Strait Islander peoples, recognising the profound and disproportionate impacts these intersecting issues have on Indigenous communities globally.

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1 John Hunter Hospital, Newcastle, NSW
2 University of Newcastle, Newcastle, NSW
3 Hunter Medical Research Institute, Newcastle, NSW
4 University of New South Wales, Sydney, NSW
5 Macquarie University, Sydney, NSW

Correspondence: i.ludbrook@student.unsw.edu.au

Open access:

Open access publishing facilitated by University of New South Wales, as part of the Wiley – University of New South Wales agreement via the Council of Australian University Librarians.

Competing interests:

Kelvin Kong is a Guest Editor for the 2025 NAIDOC Week MJA Special Issue and was not involved in any editorial decision making about this article.

Author contributions:

Tongs G: Formal analysis, investigation, methodology, resources, visualization, writing – original draft, writing – review and editing. Ludbrook I: Conceptualization, formal analysis, methodology, project administration, resources, supervision, visualization, writing – original draft, writing – review and editing. Martin J: Conceptualization, formal analysis, methodology, project administration, supervision, writing – original draft, writing – review and editing. Eisenberg R: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, supervision, visualization, writing – original draft, writing – review and editing. Kong K: Conceptualization, formal analysis, investigation, methodology, resources, supervision, writing – original draft, writing – review and editing.

1. Huria T, Palmer SC, Pitama S, et al. Consolidated criteria for strengthening reporting of health research involving indigenous peoples: the CONSIDER statement. BMC Med Res Methodol 2019; 19: 173.
2. Standen JC, Spencer J, Lee GW, et al. Aboriginal population and climate change in Australia: implications for health and adaptation planning. Int J Environ Res Public Health 2022; 19: 7502.
3. The Closing the Gap Clearinghouse. Ear disease in Aboriginal and Torres Strait Islander children. Canberra: Australian Institute of Health and Welfare, 2014. https://www.aihw.gov.au/getmedia/c68e6d27‐05ea‐4039‐9d0b‐a11eb609bacc/ctgc‐rs35.pdf?v=20230605181156&inline=true (viewed May 2025).
4. Bowatte G, Tham R, Perret JL, et al. Air pollution and otitis media in children: a systematic review of literature. Int J Environ Res Public Health 2018; 15: 257.
5. Australian Institute of Health and Welfare. Aboriginal and Torres Strait Islander Health Performance Framework: summary report, August 2024. Canberra: AIHW, 2024. https://www.indigenoushpf.gov.au/getattachment/79e5f9c5‐f5b9‐4a1f‐8df6‐187f267f6817/hpf_summary‐report‐aug‐2024.pdf (viewed May 2025).
6. Morris PS, Leach AJ, Silberberg P, et al. Otitis media in young Aboriginal children from remote communities in Northern and Central Australia: a cross‐sectional survey. BMC Pediatr 2005; 5: 27.
7. Watson DS, Clapin M. Ear health of aboriginal primary school children in the Eastern Goldfields Region of Western Australia. Aust J Public Health 1992; 16: 26‐30.
8. Sherratt S. Hearing loss and disorders: the repercussions of climate change. Am J Audiol 2023; 32: 793‐811.
9. Boylan S, Beyer K, Schlosberg D, et al. A conceptual framework for climate change, health and wellbeing in NSW, Australia. Public Health Res Pract 2018; 28: 2841826.
10. Al‐Marwani S. Climate change impact on the healthcare provided to patients. Bull Natl Res Cent 2023; 47: 51.
11. Adapt NSW. Climate change impacts on our health and wellbeing. Sydney: NSW Government, 2024. https://www.climatechange.environment.nsw.gov.au/impacts‐climate‐change/climate‐impacts‐our‐health‐and‐wellbeing (viewed Apr 2025).
12. Lansbury Hall N, Crosby L. Climate change impacts on health in remote Indigenous communities in Australia. Int J Environ Health Res 2022; 32: 487‐502.
13. Department of Premier and Cabinet. Final report of the NSW Bushfire Inquiry. Sydney, 2020. https://www.nsw.gov.au/sites/default/files/noindex/2023‐06/Final‐Report‐of‐the‐NSW‐Bushfire‐Inquiry.pdf (viewed May 2025).
14. Adapt NSW. How Aboriginal culture can help us understand climate change. Sydney: NSW Government, 2024. https://www.climatechange.environment.nsw.gov.au/stories‐and‐case‐studies/how‐aboriginal‐culture‐can‐help‐us‐understand‐climate‐change (viewed Apr 2025).
15. Department of Health and Aged Care. Systematic mapping review of Australian research on climate change and health interventions. Canberra: Australian Centre for Disease Control, Australian Government; 2024. https://www.health.gov.au/sites/default/files/2024‐10/systematic‐mapping‐review‐of‐australian‐research‐on‐climate‐change‐and‐health‐interventions.pdf (viewed May 2025).
16. Gestro M, Condemi V, Bardi L, et al. Meteorological factors, air pollutants, and emergency department visits for otitis media: a time series study. Int J Biometeorol 2017; 61: 1749‐1764.
17. Brauer M, Gehring U, Brunekreef B, et al. Traffic‐related air pollution and otitis media. Environ Health Perspect 2006; 114: 1414‐1418.
18. Heinrich J, Raghuyamshi VS. Air pollution and otitis media: a review of evidence from epidemiologic studies. Curr Allergy Asthma Rep 2004; 4: 302‐309.
19. Kousha T, Castner J. The Air Quality Health Index and emergency department visits for otitis media. J Nurs Scholarsh 2016; 48: 163‐171.
20. Lukina AO, Maquiling A, Burstein B, Szyszkowicz M. Exposure to urban air pollution and emergency department visits for diseases of the ear and mastoid processes. Atmos Pollut Res 2021; 12: 101198.
21. MacIntyre EA, Karr CJ, Koehoorn M, et al. Residential air pollution and otitis media during the first two years of life. Epidemiology 2011; 22: 81‐89.
22. Zemek R, Szyszkowicz M, Rowe Brian H. Air pollution and emergency department visits for otitis media: a case–crossover study in Edmonton, Canada. Environ Health Perspect 2010; 118: 1631‐1636.
23. Haswell MR, Bethmont A. Health concerns associated with unconventional gas mining in rural Australia. Rural Remote Health 2016; 16: 3825.
24. World Health Organization. Health topics: wildfires. Geneve: WHO, 2024. https://www.who.int/health‐topics/wildfires#tab=tab_1 (viewed Apr 2025).
25. Royal Commissions. Royal Commission into National Natural Disaster Arrangements report. Canberra: Commonwealth of Australia, 2020. https://www.royalcommission.gov.au/natural‐disasters/report (viewed May 2025).
26. Di Virgilio G, Evans JP, Blake SAP, et al. Climate change increases the potential for extreme wildfires. Geophys Res Lett 2019; 46: 8517‐8526.
27. Duane A, Castellnou M, Brotons L. Towards a comprehensive look at global drivers of novel extreme wildfire events. Climatic Change 2021; 165: 43.
28. Paudel B, Chu T, Chen M, et al. Increased duration of pollen and mold exposure are linked to climate change. Sci Rep 2021; 11: 12816.
29. Byeon H. The association between allergic rhinitis and otitis media: A national representative sample of in South Korean children. Sci Rep 2019; 9: 1610.
30. Fireman P. Otitis media and nasal disease: a role for allergy. J Allergy Clin Immunol 1988; 82: 917‐926.
31. Swann T, Ogge, M. Out of season: expanding summers and shrinking winters in subtropical and temperate Australia. Canberra: Australian Institute, 2020; p 49. https://www.preventionweb.net/quick/49841 (viewed Apr 2025).
32. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 2022; 399: 629‐655.
33. Miller ME, Shapiro NL, Bhattacharyya N. Annual temperature and the prevalence of frequent ear infections in childhood. Am J Otolaryngol 2012; 33: 51‐55.
34. Tian H, Xu B, Wang X, et al. Study on the correlation between ambient environment‐meteorological factors and the number of visits of acute otitis media, Lanzhou, China. J Otol 2020; 15: 86‐94.

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Systematic review

Online first

Factors that affect the provision of medical abortion services in Australian primary care: a mixed methods systematic review

Greta Skahill and Mridula Shankar

Med J Aust || doi: 10.5694/mja2.52707
Published online: 30 June 2025

Topics

Women's health

General medicine

Statistics, epidemiology and research design

Abstract

Objectives: To synthesise primary research findings about factors that affect medical abortion provision by general practitioners, nurses, midwives, and pharmacists in Australia.

Study design: Mixed methods systematic review of peer‐reviewed primary publications of qualitative, quantitative, and mixed methods studies of the provision of medical abortion in Australian primary care, 1 January 2013 – 18 January 2025.

Data sources: MEDLINE, Scopus, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature).

Data synthesis: Twenty‐three publications satisfied our inclusion criteria. We undertook a thematic synthesis of the qualitative study findings to identify barriers and facilitators of medical abortion provision, and assessed the confidence of each review finding using the GRADE‐CERQual approach; we also compared the qualitative synthesis with quantitative study findings. We developed ten review findings grouped under three themes: moral, legal, and regulatory influences on abortion care (three review findings; very low to moderate confidence); the absence of a systems‐based approach to abortion provision (six review findings; moderate to high confidence); and early medical abortion belongs in primary care (one review finding; high confidence). Barriers to providing medical abortion include the absence of a supportive service delivery strategy, insufficient Medicare remuneration, geographic isolation, limited access to training, and colleagues who conscientiously object to abortion. Facilitators of its provision include clinician support networks and personal motivation to improve access to reproductive health care.

Conclusions: A range of individual, service level, and system factors exacerbate the effects of geographic location and financial considerations on the provision of medical abortion in Australian primary care. Our findings indicate that financial and structural support is needed for the geographic decentralisation of medical abortion training and services, the establishment of nurse‐led models of care, and the integration of abortion care into primary care.

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1 The University of Melbourne, Melbourne, VIC
2 Nossal Institute for Global Health, the University of Melbourne, Melbourne, VIC

Correspondence: gskahill@student.unimelb.edu.au

Open access:

Open access publishing facilitated by the University of Melbourne, as part of the Wiley – the University of Melbourne agreement via the Council of Australian University Librarians.

Acknowledgements:

We are grateful to Rana Islamiah Zahroh (Nossal Institute for Global Health, the University of Melbourne) for training the authors in applying GRADE‐CERQual to qualitative evidence synthesis findings. We thank Alya Hazfiarini (Nossal Institute for Global Health, the University of Melbourne) for providing input on the quality appraisals. We are grateful to Shelly Makleff (Centre for Health Equity, the University of Melbourne) for her input to our discussion of values clarification workshops for health care providers.

Competing interests:

No relevant disclosures.

Received 30 October 2024, accepted 24 February 2025

1. Starrs AM, Ezeh AC, Barker G, et al. Accelerate progress: sexual and reproductive health and rights for all. Report of the Guttmacher–Lancet Commission. Lancet 2018; 391: 2642‐2692.
2. Millar E. Abortion, decriminalisation and the medico‐legal paradigm. Soc Sci Med 2024; 355: 117098.
3. Melville C, Corbin B. Sexual and reproductive health rights in Australia: we have much to celebrate but must not be complacent. Med J Aust 2024; 220: 112‐114. https://www.mja.com.au/journal/2024/220/3/sexual‐and‐reproductive‐health‐and‐rights‐australia‐we‐have‐much‐celebrate‐must
4. Baird B. Medical abortion in Australia: a short history. Reprod Health Matters 2015; 23: 169‐176.
5. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Clinical guideline for abortion care. An evidence‐based guideline on abortion care in Australia and Aotearoa New Zealand. Updated Sept 2024. https://ranzcog.edu.au/wp‐content/uploads/Clinical‐Guideline‐Abortion‐Care.pdf (viewed Oct 2024).
6. Keogh LA, Gurrin LC, Moore P. Estimating the abortion rate in Australia from national hospital morbidity and Pharmaceutical Benefits Scheme data. Med J Aust 2021; 215: 375‐376. https://www.mja.com.au/journal/2021/215/8/estimating‐abortion‐rate‐australia‐national‐hospital‐morbidity‐and
7. Subasinghe AK, McGeechan K, Moulton JE, et al. Early medical abortion services provided in Australian primary care. Med J Aust 2021; 215: 366‐370. https://www.mja.com.au/journal/2021/215/8/early‐medical‐abortion‐services‐provided‐australian‐primary‐care
8. Bateson D, McNamee K, Harvey C. Medical abortion in primary care. Aust Prescr 2021; 44: 187‐192.
9. Seymour JW, Melville C, Grossman D, et al. Examining service delivery patterns before and after implementation of a direct‐to‐patient telehealth service providing medication abortion in Australia. Aust N Z J Obstet Gynaecol 2024; 64: 647‐650.
10. Mazza D, Deb S, Subasinghe A. Telehealth: an opportunity to increase access to early medical abortion for Australian women. Med J Aust 2020; 213: 298‐299. https://www.mja.com.au/journal/2020/213/7/telehealth‐opportunity‐increase‐access‐early‐medical‐abortion‐australian‐women
11. Australian Department of Health and Aged Care. Reforming the health system to improve sexual and reproductive care [media release]. 31 May 2024. https://www.health.gov.au/ministers/the‐hon‐ged‐kearney‐mp/media/reforming‐the‐health‐system‐to‐improve‐sexual‐and‐reproductive‐care (viewed Oct 2024).
12. Vallury K, Kelleher D, Soffi A, et al. Systemic delays to abortion access undermine the health and rights of abortion seekers across Australia. Aust N Z J Obstet Gynaecol 2023; 63: 612‐615.
13. Sarder M, Mogharbel C, Kalman T. Realising access: abortion and contraception inequities and enablers in Victoria (Women's health Victoria knowledge paper 6). Women's Health Victoria, 24 Oct 2024. https://apo.org.au/node/328761 (viewed Feb 2025).
14. Senate Community Affairs References Committee. Ending the postcode lottery: addressing barriers to sexual, maternity and reproductive healthcare in Australia. May 2023. https://parlinfo.aph.gov.au/parlInfo/download/committees/reportsen/RB000075/toc_pdf/EndingthepostcodelotteryAddressingbarrierstosexual,maternityandreproductivehealthcareinAustralia.pdf (viewed Oct 2024).
15. Baird B. Abortion care is health care. Melbourne: Melbourne University Press, 2023.
16. Mazza D. Reimagining medical abortion in Australia: what do we need to do to meet women's needs and ensure ongoing access? Med J Aust 2023; 218: 496‐498. https://www.mja.com.au/journal/2023/218/11/reimagining‐medical‐abortion‐australia‐what‐do‐we‐need‐do‐meet‐womens‐needs‐and
17. World Health Organization. Abortion care guideline. Geneva: World Health Organization, 2022. https://iris.who.int/bitstream/handle/10665/349316/9789240039483‐eng.pdf?sequence=1 (viewed Oct 2024).
18. Therapeutic Goods Administration (Australian Department of Health and Aged Care). Amendments to restrictions for prescribing of MS‐2 Step (mifepristone and misoprostol) [media release]. 11 July 2023. https://www.tga.gov.au/news/media‐releases/amendments‐restrictions‐prescribing‐ms‐2‐step‐mifepristone‐and‐misoprostol (viewed Oct 2024).
19. Marie Stopes Health. MS health: June 2023 update. Melbourne: MSI Reproductive Choices, July 2023. https://resources.mshealth.com.au/20230704‐MS‐Health‐June‐2023.pdf (viewed Oct 2024).
20. Australian Department of Health and Aged Care. Summary statistics, allied health, all professions [dataset]. Updated 22 Oct 2024. https://hwd.health.gov.au/resources/data/summary‐all.html (viewed Oct 2024).
21. Mazza D, Burton G, Wilson S, et al. Medical abortion. Aust J Gen Pract 2020; 49: 324‐330.
22. Marie Stopes Australia. Nurse‐led medical termination of pregnancy in Australia: legislative scan. Second edition. Melbourne: Marie Stopes Australia, 2022. https://resources.msiaustralia.org.au/Nurse‐led‐MToP‐in‐Australia‐legislative‐scan.pdf (viewed Oct 2024).
23. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71.
24. Tong A, Flemming K, McInnes E, et al. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol 2012; 12: 181.
25. Hong QN, Pluye P, Fàbregues S, et al. Mixed methods appraisal tool (MMAT), version 2018. User guide. 1 Aug 2018. http://mixedmethodsappraisaltoolpublic.pbworks.com/w/file/fetch/127916259/MMAT_2018_criteria‐manual_2018‐08‐01_ENG.pdf (viewed Oct 2024).
26. Hsu C, Sandford B. The Delphi technique: making sense of consensus. Practical Assessment, Research, and Evaluation 2007; 12: 10. https://doi.org/10.7275/pdz9‐th90 (viewed Oct 2024).
27. Jünger S, Payne SA, Brine J, et al. Guidance on conducting and reporting Delphi studies (CREDES) in palliative care: recommendations based on a methodological systematic review. Palliat Med 2017; 31: 684‐706.
28. Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol 2008; 8: 45.
29. Lewin S, Bohren M, Rashidian A, et al. Applying GRADE‐CERQual to qualitative evidence synthesis findings: paper 2. How to make an overall CERQual assessment of confidence and create a summary of qualitative findings table. Implement Sci 2018; 13 (Suppl 1): 11‐23.
30. Munthe‐Kaas H, Bohren MA, Glenton C, et al. Applying GRADE‐CERQual to qualitative evidence synthesis findings: paper 3. How to assess methodological limitations. Implement Sci 2018; 13 (Suppl 1): 25‐32.
31. Colvin CJ, Garside R, Wainwright M, et al. Applying GRADE‐CERQual to qualitative evidence synthesis findings: paper 4. How to assess coherence. Implement Sci 2018; 13 (Suppl 1): 33‐41.
32. Noyes J, Booth A, Lewin S, et al. Applying GRADE‐CERQual to qualitative evidence synthesis findings: paper 6. How to assess relevance of the data. Implement Sci 2018; 13 (Suppl 1): 51‐61.
33. Glenton C, Carlsen B, Lewin S, et al. Applying GRADE‐CERQual to qualitative evidence synthesis findings: paper 5. How to assess adequacy of data. Implement Sci 2018; 13 (Suppl 1): 43‐50.
34. Lee RY, Moles R, Chaar B. Mifepristone (RU486) in Australian pharmacies: the ethical and practical challenges. Contraception 2015; 91: 25‐30.
35. Newton D, Bayly C, McNamee K, et al. “… a one stop shop in their own community”: medical abortion and the role of general practice. Aust N Z J Obstet Gynaecol 2016; 56: 648‐654.
36. Keogh LA, Newton D, Bayly C, et al. Intended and unintended consequences of abortion law reform: perspectives of abortion experts in Victoria, Australia. J Fam Plann Reprod Health Care 2017; 43: 18‐24.
37. Dawson AJ, Nicolls R, Bateson D, et al. Medical termination of pregnancy in general practice in Australia: a descriptive–interpretive qualitative study. Reprod Health 2017; 14: 39.
38. Hulme‐Chambers A, Clune S, Tomnay J. Medical termination of pregnancy service delivery in the context of decentralization: social and structural influences. Int J Equity Health 2018; 17: 172.
39. de Moel‐Mandel C, Graham M, Taket A. Snapshot of medication abortion provision in the primary health care setting of regional and rural Victoria. Aust J Rural Health 2019; 27: 237‐244.
40. de Moel‐Mandel C, Graham M, Taket A. Expert consensus on a nurse‐led model of medication abortion provision in regional and rural Victoria, Australia: a Delphi study. Contraception 2019; 100: 380‐385.
41. Keogh L, Croy S, Newton D, et al. General practitioner knowledge and practice in relation to unintended pregnancy in the Grampians region of Victoria, Australia. Rural Remote Health 2019; 19: 5156.
42. Keogh LA, Gillam L, Bismark M, et al. Conscientious objection to abortion, the law and its implementation in Victoria, Australia: perspectives of abortion service providers. BMC Med Ethics 2019; 20: 11.
43. Deb S, Subasinghe AK, Mazza D. Providing medical abortion in general practice: general practitioner insights and tips for future providers. Aust J Gen Pract 2020; 49: 331‐337.
44. De Moel‐Mandel C, Taket A, Graham M. Identifying barriers and facilitators of full service nurse‐led early medication abortion provision: qualitative findings from a Delphi study. Aust J Adv Nurs 2020; 38: 18‐26.
45. Ogden K, Ingram E, Levis J, et al. Termination of pregnancy in Tasmania: access and service provision from the perspective of GPs. Aust J Prim Health 2021; 27: 297‐303.
46. Mazza D, Seymour JW, Sandhu MV, et al. General practitioner knowledge of and engagement with telehealth‐at‐home medical abortion provision. Aust J Prim Health 2021; 27: 456‐461.
47. Desai A, Maier B, James‐McAlpine J, et al. Views and practice of abortion among Queensland midwives and sexual health nurses. Aust N Z J Obstet Gynaecol 2022; 62: 219‐225.
48. Malatzky C, Hulme A. “I love my job … it's more the systems that we work in”: the challenges encountered by rural sexual and reproductive health practitioners and implications for access to care. Cult Health Sex 2022; 24: 735‐749.
49. Haas M, Church J, Street DJ, et al. How can we encourage the provision of early medical abortion in primary care? Results of a best‐worst scaling survey. Aust J Prim Health 2023; 29: 252‐259.
50. Mainey L, O’Mullan C, Reid‐Searl K. Working with or against the system: nurses’ and midwives’ process of providing abortion care in the context of gender‐based violence in Australia. J Adv Nurs 2023; 79: 1329‐1341.
51. Singh R, Mazza D, Moloney L, et al. General practitioner experiences in delivering early medical abortion services to women from culturally and linguistically diverse backgrounds: a qualitative–descriptive study. Aust J Gen Pract 2023; 52: 557‐564.
52. Saldanha S, Caddy C, Williams H, et al. Early medical abortion provision via telehealth in Victoria: a qualitative descriptive study. Aust J Gen Pract 2024; 53: 794‐798.
53. Sheeran N, Jones L, Corbin B, Melville C. Attitudes towards models of abortion care in sexual and reproductive health: perspectives of Australian health professionals. Aust J Prim Health 2024; 30: PY24100.
54. Noonan A, Millar E, Tomnay JE, et al. “Imagine if we had an actual service …”: a qualitative exploration of abortion access challenges in Australian rural primary care. Rural Remote Health 2024; 24: 9229.
55. Moulton JE, Arefadib N, Botfield JR, et al. A nurse‐led model of care to improve access to contraception and abortion in rural general practice: co‐design with consumers and providers. J Adv Nurs 2025; 81: 1019‐1037.
56. Srinivasan S, James SM, Kwek J, et al. What do Australian primary care clinicians need to provide long‐acting reversible contraception and early medical abortion? A content analysis of a virtual community of practice. BMJ Sex Reprod Health 2025; 51: 94‐101.
57. Liwanag HJ, James O, Frahsa A. A review and analysis of accountability in global health funding, research collaborations and training: towards conceptual clarity and better practice. BMJ Global Health 2023; 8: e012906.
58. Merner B, Haining CM, Willmott L, et al. Health providers’ reasons for participating in abortion care: a scoping review. Womens Health (Lond) 2024; 20: 17455057241233124.
59. Harris LH. Recognizing conscience in abortion provision. N Engl J Med 2012; 367: 981‐983.
60. Williams J, Mayes C. Abortion in Australia: what does the overturning of Roe v Wade have to do with it? [podcast]. Undisciplinary, 5 Aug 2022. https://undisciplinary.buzzsprout.com/1104002/episodes/11073451‐abortion‐in‐australia‐what‐does‐the‐overturning‐of‐roe‐v‐wade‐have‐to‐do‐with‐it (viewed Oct 2024).
61. Turner KL, Page KC. Abortion attitude transformation: a values clarification toolkit for global audiences. Chapel Hill: Ipas, 2008. https://www.ipas.org/wp‐content/uploads/2020/06/VALCLARE14‐VCATAbortionAttitudeTransformation.pdf (viewed Feb 2025).
62. Turner KL, Pearson E, George A, Andersen KL. Values clarification workshops to improve abortion knowledge, attitudes and intentions: a pre–post assessment in 12 countries. Reprod Health 2018; 15: 40.
63. Guiahi M, Wilson C, Claymore E, et al. Influence of a values clarification workshop on residents training at Catholic Hospital programs. Contracept X 2021; 3: 100054.
64. Emmerich N. The provision of abortion in Australia: service delivery as a bioethical concern. Monash Bioeth Rev 2024; 42: 200‐219.
65. Long C. Health specialists say biased Medicare rebates are costing women more [online]. ABC News (Australia), 4 Apr 2024. https://www.abc.net.au/news/2024‐04‐04/medicare‐bias‐costing‐women‐more‐mbs‐schedule/103664726?utm_campaign=abc_news_web&utm_content=link&utm_medium=content_shared&utm_source=abc_news_web (viewed Oct 2024).
66. Cheng HC, de Costa C. Abortion education in Australian medical schools. Aust N Z J Obstet Gynaecol 2021; 61: 793‐797.
67. Millar E. Abortion stigma, abortion exceptionalism, and medical curricula. Health Sociol Rev 2023; 32: 261‐276.
68. Srinivasan S, James SM, Kwek J, et al. What do Australian primary care clinicians need to provide long‐acting reversible contraception and early medical abortion? A content analysis of a virtual community of practice. BMJ Sex Reprod Health 2025; 51: 94‐101.
69. Queensland Health. Termination of pregnancy: action plan 2032. Mar 2024. https://www.health.qld.gov.au/__data/assets/pdf_file/0028/1316467/Termination‐of‐Pregnancy‐Plan_Digital.pdf (viewed Oct 2024).
70. Australian Capital Territory (Legislative Assembly). Health (Improved Abortion Access) Amendment Bill 2024. https://classic.austlii.edu.au/au/legis/act/bill/haaab2024383 (viewed June 2025).
71. Parliament of Western Australia. Abortion Legislation Reform Act 2023. https://www.legislation.wa.gov.au/legislation/statutes.nsf/law_a147399.html (viewed June 2025).
72. Mazza D, Shankar M, Botfield JR, et al. Improving rural and regional access to long‐acting reversible contraception and medical abortion through nurse‐led models of care, task‐sharing and telehealth (ORIENT): a protocol for a stepped‐wedge pragmatic cluster‐randomised controlled trial in Australian general practice. BMJ Open 2023; 13: e065137.
73. Australia Department of Health. National women's health strategy 2020–2030. Updated 31 Oct 2023. https://www.health.gov.au/sites/default/files/documents/2021/05/national‐women‐s‐health‐strategy‐2020‐2030_0.pdf (viewed Oct 2024).

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Editorial

Ending nuclear weapons, before they end us

Kamran Abbasi, Parveen Ali, Virginia Barbour, Marion Birch, Inga Blum, Peter Doherty, Andy Haines, Ira Helfand, Richard C Horton, Kati Juva, José Florencio F Lapeña, Robert Mash, Olga Mironova, Arun Mitra, Carlos A Monteiro, Elena N Naumova, David Onazi, Tilman A Ruff, Peush Sahni, James Tumwine, Carlos Umaña, Paul Yonga and Chris Zielinski

Med J Aust 2025; 222 (11): . || doi: 10.5694/mja2.52676
Published online: 16 June 2025

Topics

Global health

In May 2025, the World Health Assembly (WHA) will vote on re‐establishing a mandate for the World Health Organization (WHO) to address the health consequences of nuclear weapons and war.1 Health professionals and their associations should urge their governments to support such a mandate and support the new United Nations (UN) comprehensive study on the effects of nuclear war

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1 The British Medical Journal, London, United Kingdom
2 International Nursing Review, Sheffield, United Kingdom
3 University of Sheffield, Sheffield, United Kingdom
4 Medical Journal of Australia, Sydney, NSW, Australia
5 Medicine, Conflict and Survival, London, United Kingdom
6 International Physicians for the Prevention of Nuclear War, Hamburg, Germany
7 University of Melbourne, Melbourne, VIC, Australia
8 London School of Hygiene and Tropical Medicine, London, United Kingdom
9 International Physicians for the Prevention of Nuclear War, Springfield (OR), United States
10 The Lancet, London, United Kingdom
11 International Physicians for the Prevention of Nuclear War, Helsinki University Central Hospital, Helsinki, Finland
12 University of the Philippines System, Ermita (NCR), Philippines
13 African Journal of Primary Health Care and Family Medicine, Cape Town, South Africa
14 Stellenbosch University, Stellenbosch, South Africa
15 International Physicians for the Prevention of Nuclear War, Russian Cardiology Research and Production Complex, Sechenov University, Moscow, Russian Federation
16 International Physicians for the Prevention of Nuclear War, Ludhiana, India
17 Indian Doctors for Peace and Development, Ludhiana, India
18 Revista de Saúde Pública, São Paulo, Brazil
19 University of São Paulo, São Paulo, Brazil
20 Journal of Public Health Policy, Boston (MA), United States
21 Tufts University, Boston (MA), United States
22 International Physicians for the Prevention of Nuclear War, Society of Nigerian Doctors for the Welfare of Mankind, Abuja, Nigeria
23 Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
24 International Physicians for the Prevention of Nuclear War, University of Melbourne, Melbourne, VIC, Australia
25 National Medical Journal of India, New Delhi, India
26 All India Institute of Medical Sciences, New Delhi, India
27 Makerere University, Kampala, Uganda
28 Kabale University, Kabale, Uganda
29 International Physicians for the Prevention of Nuclear War, Costa Rican Ministry of Health, San José, Costa Rica
30 East African Medical Journal, Nairobi, Kenya
31 CA Medlynks, Nairobi, Kenya
32 Centre for Global Health, University of Winchester, Winchester, United Kingdom
33 World Association of Medical Editors, Winchester, United Kingdom

Correspondence: czielinski@ippnw.org

Author contribution statement:

Tillman Ruff and Andy Haines developed the idea of the editorial and led drafting along with Chris Zielinski. All other authors contributed significantly to the editorial content.

Competing interests:

All relevant disclosures are listed in the Supporting Information.

1. World Health Organization. Effects of nuclear weapons and nuclear war on health and health services; Executive Board 156th session [EB156/CONF./10]; 5 Feb 2025. https://apps.who.int/gb/ebwha/pdf_files/EB156/B156_CONF10‐en.pdf (viewed Mar 2025).
2. Tomonaga M. The atomic bombings of Hiroshima and Nagasaki: a summary of the human consequences, 1945–2018, and lessons for Homo sapiens to end the nuclear weapon age. Journal for Peace and Nuclear Disarmament 2019; 2: 491–517.
3. Nobel Prize Organization. Nobel Peace Prize 2024. https://www.nobelprize.org/prizes/peace/2024/summary/ (viewed Feb 2025).
4. Nobel Prize Organization. Award ceremony speech: presentation speech by Jørgen Watne Frydnes, Chair of the Norwegian Nobel Committee, 10 December 2024. https://www.nobelprize.org/prizes/peace/2024/ceremony‐speech/ (viewed Feb 2025).
5. Tannenwald N. The nuclear taboo: the United States and the normative basis of nuclear non‐use. International Organization 1999; 53: 433–468.
6. Robock A, Xia L, Harrison CS, et al. Opinion: how fear of nuclear winter has helped save the world, so far. Atmos Chem Phys 2023; 23: 6691–6701.
7. Helfand I, Haines A, Ruff T, et al. The growing threat of nuclear war and the role of the health community. World Med J 2016; 62: 86–94.
8. Kristensen H, Korda M, Johns E, et al. Status of world nuclear forces. Washington (DC):Federation of American Scientists, 2025. https://fas.org/initiative/status‐world‐nuclear‐forces/ (viewed Mar 2025).
9. Nuclear weapons ban monitor 2024. Oslo: Norwegian People's Aid, 2025. https://banmonitor.org/ (viewed Mar 2025).
10. Mecklin J, editor; Science and Security Board. Closer than ever: it is now 89 seconds to midnight. 2025 Doomsday Clock Statement. Chicago (IL): Bulletin of the Atomic Scientists, 2025. https://thebulletin.org/doomsday‐clock/2025‐statement/ (viewed Mar 2025).
11. Xia L, Robock A, Scherrer K, et al. Global food insecurity and famine from reduced crop, marine fishery and livestock production due to climate disruption from nuclear war soot injection. Nat Food 2022; 3: 586–596.
12. United Nations General Assembly. Nuclear war and scientific research [A/C.1/79/L.39]; 15 Oct 2024. https://reachingcriticalwill.org/images/documents/Disarmament‐fora/1com/1com24/resolutions/L39‐.pdf (viewed Mar 2025).
13. General Assembly Hall. General Assembly: 55th plenary meeting. Item 98 – A/79/408 DR XVII as a whole. Nuclear war effects and scientific research; 12 Apr 2024. https://reachingcriticalwill.org/images/documents/Disarmament‐fora/1com/1com24/votes‐ga/408DRXVII.pdf (viewed Mar 2025).
14. World Health Organization. Effects of nuclear war on health and health services, 2nd ed. Geneva: WHO, 1987. https://iris.who.int/handle/10665/39199 (viewed Mar 2025).
15. World Health Organization. Health and environmental effects of nuclear weapons (WHA46/30). Geneva: WHO, 1993. https://iris.who.int/bitstream/handle/10665/175987/WHA46_30_eng.pdf?isAllowed=y&sequence=1 (viewed Mar 2025).
16. Abbasi K, Ali P, Barbour V, et al. Reducing the risks of nuclear war. BMJ 2023; 382: 1682.
17. International Campaign to Abolish Nuclear Weapons. Treaty on the Prohibition of Nuclear Weapons. Geneve: ICAN, 2017. https://www.icanw.org/tpnw_full_text (viewed Mar 2025).

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Perspective

Online first

Fan‐first heat‐health protection

Angie Bone, Federico Tartarini and Ollie Jay

Med J Aust || doi: 10.5694/mja2.52662
Published online: 2 June 2025

Topics

Social determinants of health

Heat‐related illnesses occur when environmental heat stress exceeds the body's physiological limits of heat tolerance. This most often arises when these limits are already constrained by cofactors such as older age, chronic diseases and certain medications.1 Global heat‐related mortality, estimated to be about 489 000 deaths per year,2 is predicted to increase substantially as climate change progresses.3

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1 Monash Sustainable Development Institute, Monash University, Melbourne, VIC
2 Heat and Health Research Centre, University of Sydney, Sydney, NSW
3 University of Sydney, Sydney, NSW

Correspondence: angie.bone@monash.edu

Open access:

Open access publishing facilitated by Monash University, as part of the Wiley ‐ Monash University agreement via the Council of Australian University Librarians.

Acknowledgements:

Ollie Jay acknowledges funding from the National Health and Medical Research Council (NHMRC) Investigator Grant (2021/GNT2009507).

Competing interests:

Angie Bone is a Board Member of Doctors for the Environment Australia.

1. Ebi KL, Capon A, Berry P, et al. Hot weather and heat extremes: health risks. Lancet 2021; 398: 698‐708.
2. Zhao Q, Guo Y, Ye T, et al. 2021 Global, regional, and national burden of mortality associated with non‐optimal ambient temperatures from 2000 to 2019: a three‐stage modelling study Lancet Planet Health 2021; 5: e415‐e425.
3. Chen K, de Schrijver E, Sivaraj S, et al. Impact of population aging on future temperature‐related mortality at different global warming levels. Nat Commun 2024 15: 1796.
4. International Energy Agency. The Future of Cooling. Paris: IEA, 2018. https://www.iea.org/reports/the‐future‐of‐cooling (viewed Sept 2024).
5. Albanese V, Shah S, Hammet T, et al. 2024 Summer Survey Report v1.3. Sweltering Cities, 2024. https://swelteringcities.org/2024/04/04/summer‐survey‐2024/ (viewed Sept 2024).
6. Australian Council of Social Service. ACOSS Summer Heat Survey 2024. ACOSS, 2024. https://www.acoss.org.au/wp‐content/uploads/2024/03/ACOSSHeatSurveyReport2024.pdf (viewed Sept 2024).
7. United Nations Environment Programme. About Montreal Protocol [website]. https://www.unep.org/ozonaction/who‐we‐are/about‐montreal‐protocol (viewed Sept 2024).
8. Lundgren‐Kownacki K, Hornyanszky ED, Chu TA, et al. Challenges of using air conditioning in an increasingly hot climate. Int J Biometeorol 2018; 62: 401‐412.
9. Tartarini F, Schiavon S, Jay O, et al. Application of Gagge's energy balance model to determine humidity‐dependent temperature thresholds for healthy adults using electric fans during heatwaves. Build Environ 2022; 207: 108437.
10. Zhai Y, Zhang Y, Zhang H, et al. Human comfort and perceived air quality in warm and humid environments with ceiling fans. Build Environ 2015; 90: 178‐185.
11. Tartarini F, Schiavon S, Cheung T, Hoyt T. CBE Thermal Comfort Tool: Online tool for thermal comfort calculations and visualizations. SoftwareX, 2020; 12: 100563.
12. Jay O, Hoelzl R, Weets J, et al. Fanning as an alternative to air conditioning – a sustainable solution for reducing indoor occupational heat stress. Energy Build 2019; 193: 92‐98.
13. Kent MG, Huynh NK, Mishra AK, et al. Energy savings and thermal comfort in a zero energy office building with fans in Singapore. Build Environ 2023; 243: 110674.
14. Malik A, Bongers C, McBain B, et al. The potential for indoor fans to change air conditioning use while maintaining human thermal comfort during hot weather: an analysis of energy demand and associated greenhouse gas emissions. Lancet Planetary Health 2022; 6: e301‐e309.
15. McKinsey & Company. Pathways to a low‐carbon economy: Version 2 of the global greenhouse gas abatement cost curve [website]. McKinsey & Company, 2009. https://www.mckinsey.com/capabilities/sustainability/our‐insights/pathways‐to‐a‐low‐carbon‐economy#/ (viewed Sept 2024).
16. Jay O, Capon A, Berry P, et al. Reducing the health effects of hot weather and heat extremes: from personal cooling strategies to green cities. Lancet 2021; 398: 709‐724.
17. Suresh Bhuvad S, You R, Chen Q. Evaluation of physiological and thermal comfort effectiveness of ceiling fan and table fan during a heat wave. Energy Build 2024; 322: 114706.
18. Ravanelli NM, Hodder SG, Havenith G, Jay O. Heart rate and body temperature responses to extreme heat and humidity with and without electric fans. JAMA 2015; 313: 724‐725.
19. Morris NB, English T, Hospers L, et al. The effects of electric fan use under differing resting heat index conditions: a clinical trial. Ann Inter Med 2019; 171: 675‐677.
20. Morris NB, Chaseling G, English T, et al. Electric fan use for cooling during hot weather: a biophysical modelling study. Lancet Planet Health 2021; 5: e368‐e377.
21. Chaseling GK, Vargas NT, Hospers L, et al. Simple strategies to reduce cardiac strain in older adults in extreme heat. N Engl J Med 2024; 391: 1754‐1757.
22. O'Connor FK, Meade RD, Wagar KE, et al. Effect of electric fans on body core temperature in older adults exposed to extreme indoor heat. JAMA 2024; 330: 1752‐1754.
23. International Organization for Standardization. ISO 7730: 2005. Ergonomics of the thermal environment. Analytical determination and interpretation of thermal comfort using calculation of the PMV and PPD indices and local thermal comfort criteria. Edition 3. ISO, 2005. https://www.iso.org/standard/39155.html (viewed Sept 2024).
24. Sera F, Hashizume M, Honda Y, et al. Air conditioning and heat‐related mortality: a multi‐country longitudinal study. Epidemiology 2020; 31: 779‐787.
25. Gupta S, Carmichael C, Simpson C, et al. Electric fans for reducing adverse health impacts in heatwaves. Cochrane Database Syst Rev 2012; 7: CD009888.
26. Tartarini F, Jay O. Heatwatch [website]. Sydney: University of Sydney, 2024. https://heatwatch.sydney.edu.au/ (viewed Sept 2024).

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Narrative review

Current gaps in knowledge and future research directions for Aboriginal and Torres Strait Islander children with cancer

Alexandra Truong, Kayla Williams‐Tucker (Ngarluma, Wongutha, Wudjari Noongar), Ahmi Narkle (Whadjuk Goreng Noongar), Eden Slicer (Gundungurra), Jessica‐Elise Chapman (Kamilaroi, Bundjalung), Jessica Lawler, Rishi S Kotecha, Hetal Dholaria, Justine R Clark (Adnyamathanha), Alex Brown (Yuin), Raelene Endersby, Nicholas G Gottardo and Jessica Buck (Kamilaroi)

Med J Aust 2025; 222 (10): . || doi: 10.5694/mja2.52650
Published online: 2 June 2025

Topics

Neoplasms

Pediatric medicine

Summary

Paediatric cancer is the leading cause of disease‐related death in Australian children. Limited research focuses on cancer in Aboriginal and Torres Strait Islander children.
Although there appears to be a lower incidence of cancer overall in Aboriginal and Torres Strait Islander children compared with non‐Indigenous children, a high proportion of Aboriginal and Torres Strait Islander children are diagnosed with acute myeloid leukaemia.
Five‐year overall survival is lower for many cancer types in Aboriginal and Torres Strait Islander children.
There is a need for Indigenous‐specific research focused on molecular and genetic profiles, pharmacogenomics and survivorship, both within Australia and globally.
Future research in this space should be co‐designed and led by Aboriginal and Torres Strait Islander communities; alongside clinicians, researchers and services to ensure that the priorities of Aboriginal and Torres Strait Islander people are met.

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1 WA Kids Cancer Centre, The Kids Research Institute Australia, Perth, WA
2 Centre for Child Health Research, The University of Western Australia, Perth, WA
3 The University of Notre Dame Australia, Fremantle, WA
4 University of New South Wales, Sydney, NSW
5 Perth Children's Hospital, Perth, WA
6 The Kids Research Institute Australia, Adelaide, SA

Correspondence: jessica.buck@thekids.org.au

Open access:

Open access publishing facilitated by The University of Western Australia, as part of the Wiley ‐ The University of Western Australia agreement via the Council of Australian University Librarians.

Acknowledgements:

We acknowledge the First Nations Childhood Cancer Advisory Group for their advice in preparing this manuscript. We acknowledge our Elders and the communities in which we live and write. We also acknowledge First Nations people living with and passed from cancer, and their families.

Competing interests:

No relevant disclosures.

1. Australian Institute of Health and Welfare. Australia's Children. Canberra: AIHW, 2020. https://www.aihw.gov.au/reports/children‐youth/australias‐children/contents/health/health‐australias‐children (viewed Nov 2024).
2. Youlden DR, Baade PD, Green AC, et al. The incidence of childhood cancer in Australia, 1983–2015, and projections to 2035. Med J Aust 2020; 212: 113‐120. https://www.mja.com.au/journal/2020/212/3/incidence‐childhood‐cancer‐australia‐1983‐2015‐and‐projections‐2035
3. Youlden DR, Baade PD, Moore AS, et al. Childhood cancer survival and avoided deaths in Australia, 1983–2016. Paediatr Perinat Epidemiol 2023; 37: 81‐91.
4. Signorelli C, Wakefield CE, McLoone JK, et al. Childhood cancer survivors’ reported late effects, motivations for seeking survivorship care, and patterns of attendance. Oncologist 2023; 28: e276‐e286.
5. Huria T, Palmer SC, Pitama S, et al. Consolidated criteria for strengthening reporting of health research involving indigenous peoples: the CONSIDER statement. BMC Med Res Methodol 2019; 19: 173.
6. Australian Institute of Health and Welfare, Cancer Australia. Cancer in Aboriginal and Torres Strait Islander peoples of Australia: an overview (cat. no. CAN 75). Oct 2013. https://www.aihw.gov.au/reports/cancer/cancer‐in‐indigenous‐australians‐overview/summary (viewed Nov 2024).
7. Banham D, Roder D, Eckert M, et al. Cancer treatment and the risk of cancer death among Aboriginal and non‐Aboriginal South Australians: analysis of a matched cohort study. BMC Health Serv Res 2019; 19: 771.
8. Banham D, Roder D, Keefe D, et al. Disparities in breast screening, stage at diagnosis, cancer treatment and the subsequent risk of cancer death: a retrospective, matched cohort of Aboriginal and non‐Aboriginal women with breast cancer. BMC Health Serv Res 2019; 19: 387.
9. Banham D, Roder D, Brown A. Comorbidities contribute to the risk of cancer death among Aboriginal and non‐Aboriginal South Australians: analysis of a matched cohort study. Cancer Epidemiol 2018; 52: 75‐82.
10. Cunningham J, Garvey G. Are there systematic barriers to participation in cancer treatment trials by Aboriginal and Torres Strait Islander cancer patients in Australia? Aust N Z J Public Health 2021; 45: 39‐45.
11. Hansford J, Valvi S, de Boer J, et al. “If you build it, they will come”: the convergence of funding, research and collaboration in paediatric brain cancer clinical trials. Med J Aust 2024; 221: 520‐523. https://www.mja.com.au/journal/2024/221/10/if‐you‐build‐it‐they‐will‐come‐convergence‐funding‐research‐and‐collaboration
12. Bartle S, Rice M. Overrepresentation of Aboriginal children in acute myeloid leukaemia: the experience of one institution [Letter to the Editor]. J Paediatr Child Health 2000; 36: 291.
13. Jessop S, Ruhayel S, Sutton R, et al. Are outcomes for childhood leukaemia in Australia influenced by geographical remoteness and Indigenous race? Pediatr Blood Cancer 2021; 68: e28945.
14. Rotte L, Hansford J, Kirby M, et al. Cancer in Australian Aboriginal children: room for improvement. J Paediatr Child Health 2013; 49: 27‐32.
15. Youlden DR, Baade PD, McBride CA, et al. Changes in cancer incidence and survival among Aboriginal and Torres Strait Islander children in Australia, 1997–2016. Pediatr Blood Cancer 2022; 69: e29492.
16. Valery PC, Youlden DR, Baade PD, et al. Cancer survival in Indigenous and non‐Indigenous Australian children: what is the difference? Cancer Causes Control 2013; 24: 2099‐2106.
17. Valery PC, Youlden DR, Baade PD, et al. Cancer incidence and mortality in Indigenous Australian children, 1997–2008. Pediatr Blood Cancer 2013; 60: 156‐158.
18. Australian Institute of Health and Welfare. Cancer in adolescents and young adults in Australia 2023 (cat. no. CAN 151). Apr 2023. https://www.aihw.gov.au/reports/cancer/cancer‐in‐adolescents‐young‐adults‐australia‐2023/contents/summary (viewed Nov 2024).
19. Mashtoub S, Ullah S, Collinson A, et al. Childhood cancer incidence and survival in South Australia and the Northern Territory, 1990‐2017, with emphasis on Indigenous peoples. Cancers (Basel) 2024; 16: 2057.
20. Sarfati D, Garvey G, Robson B, et al. Measuring cancer in indigenous populations. Ann Epidemiol 2018; 28: 335‐342.
21. Tervonen HE, Purdie S, Creighton N. Using data linkage to enhance the reporting of cancer outcomes of Aboriginal and Torres Strait Islander people in NSW, Australia. BMC Med Res Methodol 2019; 19: 245.
22. Griffiths K, Coleman C, Al‐Yaman F, et al. The identification of Aboriginal and Torres Strait Islander people in official statistics and other data: critical issues of international significance. Stat J IAOS 2019; 35: 91‐106.
23. Christensen D, Davis G, Draper G, et al. Evidence for the use of an algorithm in resolving inconsistent and missing Indigenous status in administrative data collections. Aust J Soc Issues 2014; 49: 423‐443.
24. Abdalla T, Walwyn T, White D, et al. Hospitalizations and cost of inpatient care for physical diseases in survivors of childhood cancer in Western Australia: a longitudinal matched cohort study. Cancer Epidemiol Biomarkers Prev 2023; 32: 1249‐1259.
25. Erdmann F, Frederiksen LE, Bonaventure A, et al. Childhood cancer: survival, treatment modalities, late effects and improvements over time. Cancer Epidemiol 2021; 71: 101733.
26. Dossetor PJ, Freeman JM, Thorburn K, et al. Health services for Aboriginal and Torres Strait Islander children in remote Australia: a scoping review. PLOS Glob Public Health 2023; 3: e0001140.
27. Jessop S, Hill S, Bicanin K, et al. Aboriginal children with cancer: the patient and healthcare worker perspective. Pediatr Blood Cancer 2024; 71: e30747.
28. Jessop S, Phelan C. Health‐care workers’ understanding of and barriers to palliative care services to Aboriginal children with cancer. J Paediatr Child Health 2022; 58: 1390‐1395.
29. Steliarova‐Foucher E, Colombet M, Ries LAG, et al. International incidence of childhood cancer, 2001‐2010: a population‐based registry study. Lancet Oncol 2017; 18: 719‐731.
30. Diaz A, Soerjomataram I, Moore S, et al. Collection and reporting of Indigenous status information in cancer registries around the world. JCO Glob Oncol 2020; 6: 133‐142.
31. Valery PC, Moore SP, Meiklejohn J, Bray F. International variations in childhood cancer in indigenous populations: a systematic review. Lancet Oncol 2014; 15: e90‐e103.
32. Stammers DM, Israels SJ, Lambert PJ, Cuvelier GDE. Cancer incidence, morbidity, and survival in Canadian first nation children: a Manitoba population‐based study from the cancer in young people in Canada (CYP‐C) registry. Pediatr Blood Cancer 2014; 61: 2164‐2169.
33. Ostrom QT, Gittleman H, Xu J, et al. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2009–2013. Neuro Oncol 2016; 18 Suppl 5: v1‐v75.
34. Elwood JM, Aye PS. High incidence of medulloblastoma in Māori and Pacific populations in New Zealand. N Z Med J 2017; 130: 105‐106.
35. Nash SH, Zimpelman G, Schulz L, Hirschfeld M. Pediatric cancers among Alaska Native People. J Pediatr 2020; 227: 288‐294.
36. Marjerrison S, Pole JD, Sung L. Inferior survival among Aboriginal children with cancer in Ontario. Cancer 2014; 120: 2751‐2759.
37. Mitchell HK, Morris M, Ellis L, et al. Racial/ethnic and socioeconomic survival disparities for children and adolescents with central nervous system tumours in the United States, 2000–2015. Cancer Epidemiol 2020; 64: 101644.
38. Pugh G, Bradbeer P, Wood A, et al. Childhood cancer incidence & survival in Aotearoa, New Zealand 2010–2019. Cancer Epidemiol 2023; 86: 102433.
39. Siegel DA, Richardson LC, Henley SJ, et al. Pediatric cancer mortality and survival in the United States, 2001‐2016. Cancer 2020; 126: 4379‐4389.
40. Marjerrison S, Antillon F, Bonilla M, et al. Outcome of children treated for relapsed acute myeloid leukemia in Central America. Pediatr Blood Cancer 2014; 61: 1222‐1226.
41. Bhatia S, Gibson TM, Ness KK, et al. Childhood cancer survivorship research in minority populations: a position paper from the Childhood Cancer Survivor Study. Cancer 2016; 122: 2426‐2439.
42. Liu Q, Leisenring WM, Ness KK, et al. Racial/Ethnic differences in adverse outcomes among childhood cancer survivors: The Childhood Cancer Survivor Study. J Clin Oncol 2016; 34: 1634‐1643.
43. Emerson MA, Olshan AF, Chow EJ, et al. Hospitalization and mortality outcomes among childhood cancer survivors by race, ethnicity, and time since diagnosis. JAMA Netw Open 2022; 5: e2219122.
44. Cancer Australia. Australian Cancer Plan – Summary Report. Canberra: Australian Government, Cancer Australia, 2023. https://www.australiancancerplan.gov.au/download‐the‐plan (viewed Nov 2024).
45. Hermes A, Wiersma M, Kerridge I, et al. Beyond platitudes: a qualitative study of Australian Aboriginal people's perspectives on biobanking. Intern Med J 2021; 51: 1426‐1432.
46. Hudson M, Beaton A, Milne M, et al. He Tangata Kei Tua: Guidelines for biobanking with Māori. New Zealand: Māori and Indigenous Governance Centre, University of Waikato; 2016. https://www.waikato.ac.nz/assets/Uploads/Research/Research‐institutes‐centres‐and‐groups/Institutes/TKRI/He‐Tangata‐Kei‐Tua‐Biobanking‐Guidelines‐1.pdf (viewed Nov 2024).
47. Beaton A, Hudson M, Milne M, et al. Engaging Māori in biobanking and genomic research: a model for biobanks to guide culturally informed governance, operational, and community engagement activities. Genet Med 2017; 19: 345‐351.
48. Hudson M, Beaton A, Milne M, et al. Te Mata Ira: Guidelines for Genomic Research with Māori. New Zealand: Māori and Indigenous Governance Centre, University of Waikato; 2016. https://www.waikato.ac.nz/assets/Uploads/Research/Research‐institutes‐centres‐and‐groups/Centres/MIGC/Te‐Mata‐Ira‐Genome‐Research‐Guidelines.pdf (viewed Nov 2024).
49. Caron NR, Chongo M, Hudson M, et al. Indigenous genomic databases: pragmatic considerations and cultural contexts. Front Public Health 2020; 8: 111.
50. Claw KG, Anderson MZ, Begay RL, et al. A framework for enhancing ethical genomic research with Indigenous communities. Nat Commun 2018; 9: 2957.
51. Garrison NA, Hudson M, Ballantyne LL, et al. Genomic research through an Indigenous lens: understanding the expectations. Annu Rev Genomics Hum Genet 2019; 20: 495‐517.
52. Clark J, Buck J, Richards‐Satour A, et al. Towards precision cancer medicine for Aboriginal and Torres Strait Islander cancer health equity. Med J Aust 2024; 221: 68‐73. https://www.mja.com.au/journal/2024/221/1/towards‐precision‐cancer‐medicine‐aboriginal‐and‐torres‐strait‐islander‐cancer
53. Henare KL, Parker KE, Wihongi H, Blenkiron C, et al. Mapping a route to Indigenous engagement in cancer genomic research. Lancet Oncol 2019; 20: e327‐e335.
54. Waanders A, Brown A, Caron NR, et al. Indigenous peoples and inclusion in clinical and genomic research: understanding the history and navigating contemporary engagement. Neoplasia 2023; 37: 100879.
55. Australian Institute of Aboriginal and Torres Strait Islander Studies. AIATSIS Code of Ethics for Aboriginal and Torres Strait Islander Research. Canberra: AIATSIS, 2020. https://aiatsis.gov.au/sites/default/files/2022‐02/aiatsis‐code‐ethics‐jan22.pdf (viewed Nov 2024).
56. National Health and Medical Research Council. Ethical conduct in research with Aboriginal and Torres Strait Islander Peoples and communities: Guidelines for researchers and stakeholders. Canberra: Commonwealth of Australia, 2018. https://www.nhmrc.gov.au/about‐us/resources/ethical‐conduct‐research‐aboriginal‐and‐torres‐strait‐islander‐peoples‐and‐communities (viewed Nov 2024).
57. Anderson K, Gall A, Butler T, et al. Development of key principles and best practices for co‐design in health with First Nations Australians. Int J Environ Res Public Health 2022; 20: 147.

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Scoping review

Urgent care centres for reducing the demand on emergency departments: a scoping review of published quantitative and qualitative studies

Feby Savira, Madison Frith, Clarissa J Aditya, Sean Randall, Naomi White, Andrew Giddy, Lauren Spark, Jamie Swann and Suzanne Robinson

Med J Aust 2025; 222 (9): . || doi: 10.5694/mja2.52663
Published online: 19 May 2025

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