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Creating a culturally secure environment at OPUS
Veronique Price
creating a culturally secure environment at opus
Piece by Veronique Price and Penny O’Brien
Cultural security in the context of musculoskeletal health care
Many Aboriginal and Torres Strait Islander people experience substantial barriers to accessing health care in Australia. This contributes to ongoing health disparities and poor health outcomes experienced by Indigenous Australians. Lower access and utilization of care by Aboriginal and Torres Strait Islander people is underscored by a history of negative health care experiences, ineffective communication and resultant mistrust and suspicion of the health care system and practitioners. Many mainstream health services lack culturally secure spaces for Aboriginal and Torres Strait Islander people to access the care they need.
Cultural security is a commitment to providing services and spaces that do not compromise the cultural rights, values, beliefs, knowledge systems and expectations of Aboriginal and Torres Strait Islander people and is integral to the way we do business in health care and research.
OPUS is committed to creating a space of cultural security to allow us to meaningfully collaborate and engage with Indigenous health services, patients, community members, researchers, clinicians and students. Proudly displaying this artwork created by Taungurung Elder, Mick Harding, we hope we are not just able to create a welcoming environment for all those that work with us but it is a clear demonstration of our unwavering commitment to fostering a diverse, inclusive, equitable research centre.
This artwork has been completed by Taungurung Elder and artist Mick Harding, and tells the story of our musculoskeletal health research from an Aboriginal perspective.
The artwork
Artist Mick Harding tells of a scar tree with diamonds inside the scar that represent our Liwik or Ancestors. Our Aboriginal and Torres Strait Islander communities around Australia are represented by the designs alongside both sides of the scar and along the limbs of the tree.
The five large gum leaves on the bottom limbs represent the five management journey streams of OPUS. Two sections of wavy lines at the top and bottom of the scar, represent the journey of OPUS and how its research has a ripple effect that effects positive change within our communities.
SOMA (the Student Orthopaedic and Musculoskeletal Association) was generous enough to raise the funds to print and frame the artwork, and display it on campus, courtesy of The University of Melbourne’s Graduate Student Association. The artwork will be giclee printed on archival cotton rag and framed as requested by the artist. The artwork will be displayed in the Department of Surgery (Clinical Sciences Building Level 2 meeting room) so that it can be visible in all OPUS and Department of Surgery meetings and events.
The artist
Mick Harding is a Taungwurrung Elder and belongs to the Yowong-Illam-Baluk clan (Mansfield Region) of the Taungwurrung people. He lives with his family in the rolling foothills of Gippsland’s Strzelecki ranges, and is an active member of the Taungwurrung, local and Victorian Indigenous communities. Mick draws his inspiration from the compelling legends of his people, and weaves the images of those legends into each of his artworks.
Keen to hear more about our research into the delivery of culturally secure osteoarthritis care for indigenous australians?
Veronique Price
NEWS
OPUS Spotlight: Brooke Conley
Brooke Conley has completed her Bachelor in Exercise Science and is in her final year of Master of Physiotherapy Practice at Latrobe University in Bendigo.
She is a proud Ngiyampaa woman from Cobar, New South Wales. Her family heritage has evoked her passion for Indigenous research, which has led to her to apply for a PhD.
She aims to contribute to the OPUS ECCO program, with her research set to begin in 2021. She will investigate if physiotherapy information and education resources are culturally appropriate for Aboriginal and Torres Strait Islander people with Osteoarthritis, Rheumatoid Arthritis and Lupus.
Beyond her PhD, Brooke intends to continue exploring ways to improve Aboriginal health outcomes, in an academic role. Alongside this, she hopes to practice as a Physiotherapist and educate fellow colleagues how to improve the care provided to Aboriginal people.
Tackling Osteoarthritis in Indigenous Communities
Veronique Price
NEWS
Tackling the Burden of Osteoarthritis in Indigenous Communities
- A CALL TO ACTION -
Editorial written by OPUS PhD student Penny O’Brien
Why is osteoarthritis an important health issue?
Osteoarthritis causes pain, swelling and difficulty moving the joints. In coming years, osteoarthritis is likely to become more common as our population is becoming older and more overweight [1,2]. As people get older and heavier, the risk of developing osteoarthritis increases because the cartilage that covers healthy joints is more likely to break down. As one of the most common causes of pain and disability around the world, billions of dollars are spent each year on minimizing the health, social and economic impact of osteoarthritis [2,3]. However, until now we have rarely considered how osteoarthritis impacts Indigenous people and their communities.
What are the factors that contribute to the impact of osteoarthritis in Indigenous communities?
Indigenous communities in Australia (Aboriginal and Torres Strait Islander), New Zealand (Māori), Canada (First Nations, Inuit and Métis) and the United States of America (Alaskan Native and American Indian) experience high rates of obesity and smoking, along with low levels of physical activity. Because of this, there are high levels of chronic diseases such as heart disease, diabetes, and chronic kidney disease in these communities [4-6]. By the age of 35, more than half of all Indigenous people experience at least one chronic disease [6]. Lifestyle factors that are linked to these chronic conditions also place Indigenous people at a high risk of developing osteoarthritis. In Australia, Indigenous people are one-and-a-half times more likely to have osteoarthritis, when compared to the rest of the population [7]. Canadian First Nations are twice as likely to experience osteoarthritis compared to non-First nations [8]. In the United States, American Indians experience higher rates of this condition than any other group in the country [9]. Despite this, Indigenous people around the world seek care for joint pain at lower levels than non-Indigenous people. For example, Aboriginal and Torres Strait Islander people visit general practitioners and undergo total joint replacement at half the rate expected based on the number of people living with osteoarthritis [5, 10]. Without appropriate health care, osteoarthritis can make participation in work, sport, family and cultural engagements more difficult and this can have significant impact on emotional wellbeing. Having healthy joints means that people can move more freely along a pathway to improved health and wellbeing.
Indigenous communities in Australia (Aboriginal and Torres Strait Islander), New Zealand (Māori), Canada (First Nations, Inuit and Métis) and the United States of America (Alaskan Native and American Indian) experience high rates of obesity and smoking, along with low levels of physical activity. Because of this, there are high levels of chronic diseases such as heart disease, diabetes, and chronic kidney disease in these communities [4-6]. By the age of 35, more than half of all Indigenous people experience at least one chronic disease [6]. Lifestyle factors that are linked to these chronic conditions also place Indigenous people at a high risk of developing osteoarthritis. In Australia, Indigenous people are one-and-a-half times more likely to have osteoarthritis, when compared to the rest of the population [7]. Canadian First Nations are twice as likely to experience osteoarthritis compared to non-First nations [8]. In the United States, American Indians experience higher rates of this condition than any other group in the country [9]. Despite this, Indigenous people around the world seek care for joint pain at lower levels than non-Indigenous people. For example, Aboriginal and Torres Strait Islander people visit general practitioners and undergo total joint replacement at half the rate expected based on the number of people living with osteoarthritis [5, 10]. Without appropriate health care, osteoarthritis can make participation in work, sport, family and cultural engagements more difficult and this can have significant impact on emotional wellbeing. Having healthy joints means that people can move more freely along a pathway to improved health and wellbeing.
Osteoarthritis is an unmet health need for Indigenous people [11]. Until now, health care providers, researchers and policymakers have focused most of their attention on conditions that directly contribute to ‘the gap’ in life expectancy for Indigenous people. Focusing on areas such as diabetes, heart disease and childhood health is certainly important. However, as the leading cause of mobility limitation, osteoarthritis contributes indirectly to life expectancy [12]. Pain and stiffness caused by osteoarthritis can make it harder to exercise, which makes it difficult to manage other chronic conditions. Because of this, we can view osteoarthritis as a central piece of the chronic disease puzzle, which must be addressed if we are to eliminate inequalities in life expectancy. Treating osteoarthritis as a priority can help Indigenous people live longer lives, free from pain and disability.
What can we do about it?
By improving the joint health of Indigenous people, we have an opportunity to improve the wellbeing of Indigenous communities. We therefore call on health care providers, researchers and policymakers to:
- Recognise that osteoarthritis is a leading cause of pain and mobility difficulties among Indigenous people and is therefore a central piece in the chronic disease puzzle. Building capacity in the Indigenous health workforce to recognize and manage osteoarthritis must be a priority. This may be achieved by widespread education and training of the health workforce.
- Engage Indigenous people in research efforts to generate a much-needed understanding of the experience of osteoarthritis from an Indigenous perspective. More Indigenous researchers working in musculoskeletal health also means that more researchers will adopt an Indigenous view of health in their work.
- Provide culturally secure osteoarthritis care for Indigenous communities. Cultural security means that health services are committed to providing care that upholds the cultural rights, values knowledge systems and expectations of Indigenous people [13]. Embedding these principles into health care means that more Indigenous people will be able to receive the care that they need for their joint pain, so that they can remain active, healthy members of their communities.
It is now time to take musculoskeletal health off the backburner and recognise the central role that osteoarthritis and joint pain plays in managing chronic disease in Indigenous communities. We need to keep Indigenous peoples on their feet, so they can walk the path to improved health and wellbeing.
- Wittenauer, R.; Smith, L.; Aden, K. Background Paper 6.12 Osteoarthritis. Priority Medicines for Europe and the World: 2013 Update; World Health Organization Essential Medicine and Health Product Information Portal: Geneva, Switzerland, 2013.
- Hunter, D.J.; Schofield, D.; Callander, E. The individual and socioeconomic impact of osteoarthritis. Nat. Rev. Rheumatol. 2014, 10, 437–441.
- Chen AG, Gupte C, Akhtar K, Smith P, Cobb J. The global economic cost of osteoarthritis: how the UK compares. Arthritis. 2012.
- Australian Institute of Health andWelfare. Australia’s Health 2014; Australian Institute of Health and Welfare: Canberra, Australia, 2014.
- Brand, C.A.; Harrison, C.; Tropea, J.; Hinman, R.S.; Britt, H.; Bennell, K. Management of osteoarthritis in general practice in Australia. Arthritis Care Res. 2014, 66, 551–558.
- United Nations. State of the World’s Indigenous Peoples; United Nations Publications: New York, NY, USA, .
- Australian Institute of Health andWelfare. Australia’s Health 2018; Australian Institute of Health and Welfare:Canberra, Australia, 2018.
- Barnabe, C.; Hemmelgarn, B.; Jones, C.A.; Peschken, C.A.; Voaklander, D.; Joseph, L.; Bernatsky, S.; Esdaile, J.M.; Marshall, D.A. Imbalance of prevalence and specialty care for osteoarthritis for first nations people in Alberta, Canada. J. Rheumatol. 2015, 42, 323–328.
- Bolen, J.; Schieb, L.; Hootman, J.M.; Helmick, C.G.; Theis, K.; Murphy, L.B.; Langmaid, G. Di_erences in the prevalence and severity of arthritis among racial/ethnic groups in the United States, National Health Interview Survey, 2002, 2003, and 2006. Prev. Chronic Dis. 2010, 7, A64.
- Dixon, T.; Urquhart, D.M.; Berry, P.; Bhatia, K.; Wang, Y.; Graves, S.; Cicuttini, F.M. Variation in rates of hip and knee joint replacement in Australia based on socio-economic status, geographical locality, birthplace and indigenous status. ANZ J. Surg. 2011, 81, 26–31.
- Lin, I.B.; Bunzli, S.; Mak, D.B.; Green, C.; Goucke, R.; Co_n, J.; O’Sullivan, P.B. Unmet needs of Aboriginal Australians with musculoskeletal pain: A mixed-method systematic review. Arthritis Care Res. 2018, 70, 1335–1347.
- Cross, M.; Smith, E.; Hoy, D.; Nolte, S.; Ackerman, I.; Fransen, M.; Bridgett, L.;Williams, S.; Guillemin, F.; Hill, C.L.; et al. The global burden of hip and knee osteoarthritis: Estimates from the global burden of disease 2010 study. Ann. Rheum. Dis. 2014, 73, 1323–1330.
- Coffin, J. Rising to the challenge in Aboriginal health by creating cultural security. Aborig. Isl. Health Work J. 2007, 31, 22.
Keen to hear more about our research into the delivery of culturally secure osteoarthritis care for indigenous australians?
Veronique Price
OUR PEOPLE
- Osteoarthritis
- Childhood obesity
- Data registries
Veronique Price
BBmed (Honours)
Veronique is a Research Administrative Assistant with OPUS, working behind the scenes to support the Centre. She completed a Bachelor of Biomedicine with Honours at the University of Melbourne, and spent her research year investigating the lifestyle factors that protect children of parents with obesity from becoming overweight, at the Murdoch Children’s Research Institute. She hopes to soon publish her findings as she is passionate about children’s and public health.
Veronique splits her time with OPUS between supporting the Centre Manager with various administrative tasks, liaising with the Student Orthopaedic and Musculoskeletal Association (SOMA), running the OPUS social media accounts and assisting with the SOCRATES data registry and projects in Stream 2.
OTHER KEY ROLES
OPUS Data Linkage, Translation & Engagement, and Education & Training Committees: Member
Student Orthopaedic and Musculoskeletal Association: Member
Veronique Price
OUR PEOPLE
- Pain-related beliefs
- Knee osteoarthritis
- Lower back pain
- Qualitative Research
Tara Binnie
PhD, MPH, BBmedSci (Hon)
Tara is a senior physiotherapist currently undertaking a PhD at Curtin University with the OPUS Centre for Research Excellence. She is working to assess the utility of wearable sensors in measuring pain-related disability (movement quality) in patients with knee osteoarthritis that also have lower back pain. She will also explore the association between movement and pain-related beliefs and emotions in individuals with knee OA and examine how movement, beliefs and emotions change over time relative to each other, in individuals with knee OA undergoing a physiotherapy intervention. She hopes to develop an intervention that can target all these factors, to enable better long-term pain and disability outcomes in this population.
Tara also lectures at Curtin Universityand has previously conducted research into knee injuries. Prior to embarking on a career in physiotherapy, Tara was a professional international volleyball player. She captained the Australian Women’s Indoor Volleyball Team before moving to a successful career on the beach including partnering 5 time Olympian and Sydney 2000 Gold Medallist Natalie Cook on the World Beach Tour. She now combines this with her physiotherapy skills to look after the Western Australian Volleyball Teams including their injury prevention and conditioning programs.
SCHOLARSHIPS:
Research Training Program (RTP) Stipend Scholarship
Curtin Research Scholarship (CRS)
OTHER KEY ROLES:
Star Physiotherapy Clinic: Senior Physiotherapist
Curtin University: Sessional Academic
Veronique Price
OUR PEOPLE
- Cost-effectiveness
- Length of stay
- Total joint arthroplasty
Siddharth Rele
BBiomedSc, MD (enrolled)
Siddharth (Sid) is a medical student involved in stream 4 of the OPUS CRE. His research currently focuses on the length of stay for patients undergoing joint replacement surgery. Sid’s specific research interest is investigating the effect reducing length of stay on short- and long-term patient outcomes and their related costs.
His broader research interest also includes patient-related factors that impact outcomes of total joint replacement.
AWARDS/SCHOLARSHIPS
Australian Orthopaedic Association Joint University Scholarship (2019);
James and Betty McCreery Travelling Scholarship (2019)
OTHER KEY ROLES
Student Orthopaedic and Musculoskeletal Association (SOMA): Treasurer
Veronique Price
OUR PEOPLE
- Biostatistics
- Total knee replacement
- General practice
Sharmala Thuraisingam
Mbiostatistics, BMechEng, PhD (enrolled)
Sharmala (Sharm) Thuraisingam is a PhD candidate in the OPUS CRE. She also works as a Biostatistician at the Department of General Practice and research assistant at the Department of Surgery, The University of Melbourne. Sharm’s research is focussed on the development of a prediction model for use in general practice to predict non-response to total knee replacement in patients with osteoarthritis. This model will utilise data from the St Vincent’s Hospital SMART registry and general practice patient data from the Department of General Practice and the Australian Institute of Health and Welfare (AIHW).
OTHER KEY ROLES
Department of General Practice, The University of Melbourne: Biostatistician
Department of Surgery, The University of Melbourne: Research Assistant
Veronique Price
OUR PEOPLE
- Knee osteoarthritis
- Aboriginal health
- Qualitative research
Penny O'Brien
BHlthSc (Hon), PhD (enrolled)
Penny O’Brien is a current PhD candidate and qualitative researcher at OPUS. Penny’s PhD explores the impact of osteoarthritis on Aboriginal and Torres Strait Islander Australians, a research area which has received little or no attention in Australia to date. As a novel research field, Penny also aims to investigate and evaluate the process of establishing a program of Aboriginal health research in a non-Aboriginal research group. This aspect of the PhD will explore partnership building, capacity building and culturally secure research methods to inform future research professionals initiating Aboriginal health research. Penny is also employed concurrently by the Department of surgery to coordinate qualitative research projects and to develop and facilitate a qualitative research methods training course. Within this position she hopes to contribute to the development of culturally secure arthritis education resources for Aboriginal and Torres Strait Islander people.
Penny also represents OPUS graduate researchers as an OPUS Executive committee member and is a foundation member of SOMA, the Student Orthopaedic and Musculoskeletal Association in which she fulfills a community engagement role.
Grants
- O’Brien, P (CIA), Bunzli, S., Dowsey, M., Lin, I. & Choong, P. (2019). St. Vincent’s Health Australia Inclusive Health Fund. The OPUS Community Reference Group for Enhancing Equity, Collaboration and Culturally secure Osteoarthritis Care for Aboriginal Australians. $16,045
- Bunzli, S (CIA)…O’Brien P (AI) (2018). St Vincent’s Hospital Melbourne Research
- Endowment Fund. Health-related quality of life in Aboriginal Australians with osteoarthritis. Application 88268. $19,992.
- Gunatillake, T (CIA)…O’Brien P (AI) (2019). St Vincent’s Hospital Melbourne Research Endowment Fund. The ‘in-patient’ study: exploring the knowledge and understanding of osteoarthritis in Aboriginal and/or Torres Strait Islander patients admitted at SVHM. Application 90200. $16,938.
OTHER KEY ROLES
Department of Surgery, University of Melbourne – coordinates qualitative components of a range of projects: Qualitative Trials Coordinator
Student Orthopaedic and Musculoskeletal Association (SOMA): Community Engagement Officer
Veronique Price
OUR PEOPLE
- Kneearthroplasty
- Patient satisfaction
- Qualitative research
Nardia-Rose Klem
BSc Physio (Hon); PhD
Nardia is a clinical physiotherapist who has completed her PhD at Curtin University with the OPUS Centre for Research Excellence. At OPUS, Nardia is working to gain a better understanding of success after TKR, through both better understanding patient satisfaction and exploring the cross-over between satisfaction and patient-reported changes in pain and function outcomes. The study combines interviews from 40 people who have undergone a total knee replacement surgery, with data from 500 people from the total knee replacement registry based at St Vincent’s Hospital in Melbourne. These data will be compared to create a bigger picture of ‘success’ and potentially inform the variables that influence individuals to having a ‘successful’ total knee replacement.
SCHOLARSHIPS
Research Training Program Stipend scholarship
OTHER KEY ROLES
Physiotherapist
Curtin University: Research Assistant
Curtin University, School of Physiotherapy: Undergraduate Tutor
Veronique Price
OUR PEOPLE
- Qualitative Research
- Primary Care
- Chronic Illness
Michelle Tew
MPH; MPharm; PhD (enrolled)
Michelle Tew is a PhD Candidate at the OPUS Centre for Research Excellence and is a Health Economics Research Fellow at the Centre for Health Policy, Melbourne School of Population and Global Health. Her research interests include economic evaluation and modelling, health services utilisation, prescription medications and using patient-reported outcomes to guide value-based care.
Her current research project focuses on the health economics of infections in cancer patients and patients undergoing lower limb arthroplasty. Her research aims to maximise the use of longitudinal data to better understand patterns of health outcomes and health service use, and to develop and test economic evaluation methods to provide valuable input and better inform health policy decisions.
OTHER KEY ROLES
Melbourne School Of Population And Global Health: Health Economics Research Fellow
Medical Services Advisory Committee (MSAC), Department of Health: Member
Veronique Price
OUR PEOPLE
- Musuloskeletal pain
- Osteoarthritis
- Cognitive Functional Therapy
Jay-Shian Tan
MPhty, BSc (Phys), PhD (enrolled)
Jay is a Musculoskeletal Physiotherapist currently undertaking a PhD in Physiotherapy at Curtin University and the OPUS Centre for Research Excellence. He currently consults on a part time basis, working with people with complex and chronic musculoskeletal pain conditions.
Jay’s studies will explore the use of wireless movement sensors that provide joint angle and muscle activity data for people with knee osteoarthritis. If these sensors are successful in detecting movement, clinicians may be able to use them to assess the movement of their patients outside the clinical environment. He also plans to investigate the role of these sensors in detecting changes in movement after Cognitive Functional Therapy to determine if a change in movement is associated with a change in disability and pain.
OTHER KEY ROLES
Musculoskeletal Physiotherapist
Musculoskeletal Physiotherapy Association WA: Chair
InTouch Magazine: Clinical Editor
Curtin University, School of Physiotherapy: Postgraduate Tutor/Clinical Supervisor
Veronique Price
OUR PEOPLE
- Total joint replacement surgery
- Osteoarthritis
- Waste minimisation
Dr Jason Trieu
MD, PhD (enrolled)
Total joint replacement surgery is highly effective for end-stage symptomatic osteoarthritis of the hip and knee. In Australia we currently perform more than 100,000 of these procedures each year, but at a cost of greater than $2 billion. Dr Trieu’s PhD research is going to critically examine the fundamental cost basis of performing total joint replacement surgery in Australia to identify areas where we can refine our practices to minimise waste and inefficiencies whilst maintaining the standard of care we provide for our patients, and will attempt to identify relationships between these underlying variables and their relation to long-term patient outcomes on a population level.
Research publications
SCHOLARSHIPS
Research Training Program Scholarship
OTHER KEY ROLES
Medical Doctor