Closing the gaps in and through Indigenous health research: Guidelines, processes and practices

Abstract

Research in Aboriginal contexts remains a vexed issue given the ongoing
inequities and injustices in Indigenous health. It is widely accepted that good
research providing a sound evidence base is critical to closing the gap in Aboriginal
health and wellbeing outcomes. However, key contemporary research issues still
remain regarding how that research is prioritised, carried out, disseminated and
translated so that Aboriginal people are the main beneficiaries of the research in
every sense. It is widely acknowledged that, historically, research on Indigenous
groups by non-Indigenous researchers has benefited the careers and reputations of
researchers, often with little benefit and considerably more harm for Indigenous
peoples in Australia and internationally. This paper argues that genuine collaborative
and equal partnerships in Indigenous health research are critical to enable
Aboriginal and Torres Islander people to determine the solutions to close the
gap on many contemporary health issues. It suggests that greater recognition of
research methodologies, such as community participatory action research, is necessary
to ensure that Aboriginal people have control of, or significant input into,
determining the Indigenous health research agenda at all levels. This can occur at a
national level, such as through the National Health and Medical Research Council
(NHMRC) Road Map on Indigenous research priorities (RAWG 2002), and at a
local level through the development of structural mechanisms and processes, including
research ethics committees’ research protocols to hold researchers accountable
to the NHMRC ethical guidelines and values which recognise Indigenous culture in
all aspects of research.

Full text

Australian Aboriginal Studies 2010/2 81
Closing the gaps in and through Indigenous health
research: Guidelines, processes and practices
Pat Dudgeon
School of Indigenous Studies, The University of Western Australia
Kerrie Kelly
Australian Indigenous Psychologists Association
Roz Walker
Centre for Child Development, The University of Western Australia,
and Telethon Institute for Child Health Research
Abstract: Research in Aboriginal contexts remains a vexed issue given the on going
inequities and injustices in Indigenous health. It is widely accepted that good
research providing a sound evidence base is critical to closing the gap in Aboriginal
health and wellbeing outcomes. However, key contemporary research issues still
remain regarding how that research is prioritised, carried out, disseminated and
translated so that Aboriginal people are the main beneficiaries of the research in
every sense. It is widely acknowledged that, historically, research on Indigenous
groups by non-Indigenous researchers has benefited the careers and reputations of
researchers, often with little benefit and considerably more harm for Indigenous
peoples in Australia and internationally. This paper argues that genuine collabo-
rative and equal partnerships in Indigenous health research are critical to enable
Aboriginal and Torres Islander people to determine the solutions to close the
gap on many contemporary health issues. It suggests that greater recognition of
research methodologies, such as community participatory action research, is neces-
sary to ensure that Aboriginal people have control of, or significant input into,
determining the Indigenous health research agenda at all levels. This can occur at a
national level, such as through the National Health and Medical Research Council
(NHMRC) Road Map on Indigenous research priorities (RAWG 2002), and at a
local level through the development of structural mechanisms and processes, includ-
ing research ethics committees’ research protocols to hold researchers accountable
to the NHMRC ethical guidelines and values which recognise Indigenous culture in
all aspects of research.

82 Australian Aboriginal Studies 2010/2
Closing the gaps in and through Indigenous health research Dudgeon
Introduction
Drawing on the current relevant national — and
to a lesser extent, international — literature,
this paper first examines some of the para doxes
regarding the implementation gap between
governance, structures, funding and accounta-
bility practices and existing National Health and
Medical Research Council (NHMRC) Indigenous
research and ethics guidelines ; second, it describes
two case studies as exemplars of good research
processes and practices that attempt to address
these concerns; and, finally, it suggests that there
is a critical need to incorporate cultural compe-
tence at a system, organisational and individ-
ual level to ensure that all researchers are more
culturally responsive and sensitive in developing,
implementing and disseminating research in part-
nership with Aboriginal and Torres Strait Islander
people.
The research history within Aboriginal and
Torres Strait Islander contexts
In Australia the history and practice of health
research with Indigenous peoples is bound up
with colonisation and exploitation (Henry et al.
2004 ; Humphery 2002; Nakata 2007; Rigney
1997). The first national conference to discuss
Aboriginal health research ethics highlighted
concerns about matters of ownership and control
of the research agenda in Aboriginal and Torres
Strait Islander contexts. Held in Alice Springs in
1986, the conference (entitled ‘Research Priorities
to Improve Aboriginal Health’) was hosted by
the Special Purposes Committee of the NHMRC
and the Menzies School of Health Research. At
the meeting, many researchers had their prac-
tices challenged by Aboriginal and Torres Strait
Islander people for the first time. Conference dele-
gates introduced a broad agenda to institution-
ally re-position the funding, conduct and control
of Aboriginal and Torres Strait Islander health
research away from traditional research establish-
ments and funding bodies (Humphrey 2002).
Subsequently, a working party of Aboriginal
people was formed to work in partnership with
the NHMRC to draft the Interim Guidelines on
Ethical Matters in Aboriginal and Torres Strait
Islander Health Research (NHMRC 1991), which
were issued in 1991. While the interim guidelines
had a high degree of community ownership and
were endorsed by the National Aboriginal and
Islander Health Organisation, issues related to
Indigenous control of Indigenous research fund-
ing and outcomes remained contentious, and
the guidelines were not formally ratified by the
NHMRC before being revised and re-issued
in 2003. Nevertheless, the guidelines served to
transform research practice with Aboriginal and
Torres Strait Islander people and communities
(Humphery 2002).
The NHMRC Guidelines for Ethical
Indigenous Research
One of the most recent sets of guidelines, the
NHMRC (2003) Values and Ethics: Guidelines
for ethical conduct in Aboriginal and Torres
Strait Islander health research and the updated
NHMRC (2007) National Statement of Ethical
Conduct in Human Research, has evolved from a
history of changing contexts in governmental and
institutional policies and stronger engagement of
Indigenous people in research (Anderson 2003).
These guidelines explicitly acknowledge the role
of research in colonisation and assimilation and
the significant impact on Aboriginal and Torres
Strait Islander people (NHMRC 2003:2). They
urge researchers to ‘make particular effort to
deal with the perception of research held by many
Aboriginal and Torres Strait Islander communi-
ties as an exploitative exercise’, and to ‘demon-
strate through ethical negotiation, conduct and
dissemination of research that they are trust-
worthy and will not repeat the mistakes of the
past’ (NHMRC 2003:18).
The 2003 NHMRC guidelines have been
described as an attempt to decolonise research
in Australia (de la Barra 2007). They remind
researchers that, first, ‘failing to understand
difference in values and culture may be a reckless
act that jeopardises both the ethics and quality
of research’ and, second, that ‘failing to recog-
nise cultural difference can inflict harm, can be
a form of oppression, imprisoning someone [or
a group] in a false, distorted and reduced model
of being’ (NHMRC 2003:2). The guidelines take
account of the continuing concerns of Aboriginal
and Torres Strait Islander peoples regarding ‘poor
consultation, lack of communication and infringe-

Australian Aboriginal Studies 2010/2 83
Dudgeon Closing the gaps in and through Indigenous health research
ment of deeply held values arising from cross-
cultural insensitivity’ (NHMRC 2003:4).
Further, the guidelines emphasise the need to
acknowledge cultural differences and considera-
tion of cultural values. They are based on six core
values: reciprocity, respect, equality, responsibil-
ity, survival and protection, and spirit and integ-
rity. They state that, where possible, Indigenous
people should be part of the research planning,
that the research should benefit the community,
that Indigenous knowledge systems and processes
should be respected, that Indigenous research-
ers and community members should be an active
part of the research, and that informed under-
standing and consent is a necessary characteristic
throughout the research project. The NHMRC’s
(2005) Keeping Research on Track: A guide for
Aboriginal and Torres Strait Islander peoples
about health research ethics is a companion
resource (to the 2003 guidelines) for Aboriginal
and Torres Strait Islander people when making
decisions about health research in their commu-
nities. An example of such research is presented
later (Case study 2) to demonstrate how these
values and resources are integrated into a commu-
nity-based health research study.
The Aboriginal and Torres Strait Islander
Research Reform Agenda
In the early 2000s the Cooperative Research
Centre for Aboriginal and Tropical Health (later
the Cooperative Research Centre for Aboriginal
Health (CRCAH) and, most recently, the Lowitja
Institute) was established to improve Aboriginal
health through effective research. Reasserting
the broader agenda set at the 1986 conference,
Henry and colleagues at the CRCAH called on
‘researchers, research organisations, the acad-
emy, funding bodies and higher education institu-
tions’ to ‘justify their involvement in Indigenous
health research’ (Henry et al. 2002a:4). They
proposed an Indigenous Research Reform Agenda
(IRRA), which recognises that radical changes
are required in how Indigenous health research
is approached, including the way that institutions
actualise, process and monitor research (Henry
et al. 2002a). Key IRRA principles advocated by
Humphery (2001) include Indigenous community
involvement in the prioritisation, design, execu-
tion and evaluation of research; mechanisms for
Indigenous control, ongoing surveillance and
transformation of research; and determination
of ethical processes for the conduct of research
in terms of consultation and negotiation. Other
principles include:
• transformation of research practices from
‘investigator-driven’ to a re-assertion of control
by Indigenous community-controlled organisa-
tions over the research project and an adoption
of the needs-based approach to research
• linkage between research and community
development and social change
• thetrainingofIndigenousresearchers
• the adoption of effective mechanisms for the
dissemination and transfer of research findings
• ownership and control of research ndings
by Aboriginal communities (Henry et al.
2004 :10).
A full discussion of the IRRA can be found in the
Links Monographs (Henry et al. 2002a, 2002b,
2004). The IRRA has strong Indigenous commu-
nity support and has been theorised, articulated
and promoted by both Aboriginal and Torres Strait
Islander representatives and their allies across a
range of disciplines within higher education insti-
tutions and research organisations throughout
Australia (Monk et al. 2009). An important focus
of the IRRA is the formalisation of Indigenist
research philosophies, principles and practices to
legitimise and validate Indigenous peoples’ ways
and practices.
The role of human research ethics
committees
Despite the sustained effort of Aboriginal and
Torres Strait Islander people over a number of
years and the development of Indigenous research
guidelines, non-Indigenous researchers have
largely retained control over the initiation, proc-
ess, evaluation and dissemination of research into
Aboriginal health and wellbeing. Most institu-
tions involved with research about Aboriginal
and Torres Strait Islander peoples and issues have
adopted guidelines and protocols to guide research
(see, for example, AIATSIS 2000; Walker et al.
2001).
However, while the Human Research Ethics
Committee (HREC) system and values and ethics
guidelines are valuable tools, concerns have been
raised (Humphery 2002) that HRECs are not

84 Australian Aboriginal Studies 2010/2
Closing the gaps in and through Indigenous health research Dudgeon
across all phases of Aboriginal and Torres Strait
Islander research. Further, only 30 of 200 HRECs
have Aboriginal and Torres Strait Islander members
on their committees.1 While most research institu-
tions require evidence of consultation with rele-
vant Aboriginal groups prior to granting ethics
approval, there is concern that once a research
project has received ethics approval, there are
no mechanisms in place to monitor, evaluate or
report on research outcomes (Dunbar et al. 2003).
Several universities and research institutes are
successfully addressing such concerns and adopt-
ing decolonising approaches. There are examples
where Aboriginal health ethics committees and
sub-committees have extended their role for the
approval process to involve ongoing accountability
and monitoring in line with the recommendations
(Dunbar et al. 2003). There are a number of good
examples of processes put in place by HRECs in
universities and institutions throughout Australia
in consultation with Indigenous people to address
such concerns. For instance, all Aboriginal health
research undertaken by staff and students at The
University of Western Australia must comply
with the NHMRC (2003, 2007) values and prin-
ciples relating to research with Aboriginal and
Torres Strait Islander people. All research propos-
als submitted must specifically address the six
core values mentioned previously. In addition,
researchers are required to submit their propos-
als to the Western Australian Aboriginal Health
Information and Ethics Committee (WAAHIEC)
for approval. In turn, WAAHIEC requires a
demonstration that relevant Aboriginal groups
have been consulted prior to the proposal and that
processes are in place to communicate, dissemi-
nate and translate research with community
involvement. There are also additional require-
ments to go through the Aboriginal Community
Controlled Health Services in most regions. These
processes are in accordance with recommenda-
tions to address the concerns outlined previously
(Dunbar et al. 2003).
Part of the dilemma for researchers is that work-
ing in accordance with these values for the bene-
fit of Aboriginal and Torres Strait Islander people
may conflict with existing mainstream funding and
career expectations. Within this context, consid-
eration needs to be given by NHMRC and other
competitive research funding bodies to chang-
ing the criteria for evaluating research perform-
ance — shifting the focus away from the number
of peer-reviewed journal publications to requir-
ing researchers to provide evidence of meaningful
implementation and translation of research find-
ings into policy and practice in accordance with
Indigenous research interests and priorities. A
broader evaluation process is required that takes
into account the research process and community
perspectives of the process and the final product,
since it is only after research has been conducted
that researchers prove themselves trust worthy
through both the process and the results they
deliver to improve health and wellbeing outcomes
with and for Indigenous people (Henry et al.
2002a).
Decolonising research and collaborative
relationships
A paradigm shift is gradually occurring as
evidenced in the work of Indigenous schol-
ars such as Jahnke and Taiapa (1999), Martin
(2008), Moreton-Robinson and Walter (2010),
and Smith (1999). Collaborative and participa-
tory research methodologies are generally iden-
tified as being compatible with the goals of the
emerging Indigenous agenda for research reform
in Australia and internationally. The increasing
focus on bottom-up participatory approaches is
seen to have come from the failure of centralised
or top-down approaches to deliver sustain able
improvement to the lives of Indigenous people
who have been the subjects of research in a global
context (Bishop 2005; Jahnke and Taiapa 1999;
Smith 1999).
Tsey (2001) suggests that if research organi-
sations are to become more relevant to the needs
and aspirations of Australian Indigenous peoples,
they need to enter into collaborative partnerships
with Indigenous organisations and communi-
ties. He makes the point that genuine collabora-
tive research requires time, commitment and hard
work, and ‘a longer term approach to Indigenous
health research, including the development of stra-
tegic alliances’ (Tsey 2001:23). Such an approach
also requires restructuring the methodology to
focus on relationship building and the research
process, rather than the usual emphasis solely
on outcomes. Case study 2, below, demonstrates
that health research that focuses on building such

Australian Aboriginal Studies 2010/2 85
Dudgeon Closing the gaps in and through Indigenous health research
partnerships at the community level can have a
range of positive health impacts.
Collaborative relationships and
partnerships to close the gap
Partnerships between Indigenous and non-
Indigenous Australians have emerged as a key
issue in government policy to ‘close the gap’
in Indigenous health inequality. The Close the
Gap campaign launched in March 2008 and
the Council of Australian Governments made a
commitment to a partnership between all levels of
government and Indigenous Australian communi-
ties. The aim was to close the life expectancy gap
within a generation and to halve the mortality rate
for Aboriginal and Torres Strait Islander children
under the age of five within a decade. In Close
the Gap: National Indigenous Health Equality
Targets (HREOC 2008:22), this commitment
includes a discrete partnership target to achieve
the goal of ‘Aboriginal and Torres Strait Islander
community engagement, control and participation
in Indigenous health policy and program devel-
opment, implementation and monitoring’. These
targets are the first step in a continuing process
to achieve a genuine partnership between govern-
ments and Aboriginal and Torres Strait Islander
and other organisations. According to the Close
the Gap Steering Committee for Indigenous
Health Equality (2010:4–5):
Genuine partnership exists when:
two or more parties join together to work
toward a common goal; it is a process of shared
decision making, of negotiated outcomes,
and of mutual respect. It is an ongoing proc-
ess, and one that requires sustained effort
to maintain over time. At its heart, working
in partnership means that both parties have
genuine influence — in identifying issues and
developing solutions and determining the
form of partnership.
Partnerships should be transparent and involve
relevant representative bodies, acknowledge
historical and current power imbalances in order
to build capability and capacity for Indigenous
people, and involve the review and evaluation of
processes and outcomes (Close the Gap Steering
Committee for Indigenous Health Equality 2010).
Genuinely collaborative research relationships
require mutual trust, shared resources and mutu-
ally agreed goals (NHMRC 2003, 2007).
Research collaborations may be difficult to
manage in their early stages, and require consid-
erable time and patience to establish and main-
tain trusting and effective partnerships to achieve
the agreed research outcomes. There is increasing
attention in looking at ways to build and maintain
trust between research collaborations across two
very different cultures and the need for specific
training to encourage and sustain collaborations.
This paper now describes two examples
of research undertaken through the Telethon
Institute for Child Health Research in the spirit
of partnership and commitment to closing the
gap through Indigenous health research. The
first is the Western Australian Aboriginal Child
Health Survey (WAACHS), which is a compre-
hensive survey of Aboriginal health and social
and emotional wellbeing that was undertaken in
Western Australia between 2000 and 2001; the
second is the Kalgoorlie Otitis Media Research
Project.
Case study 1: The Western Australian
Aboriginal Child Health Survey
The WAACHS is an exemplar of Aboriginal
involvement in all phases of research from inception
to completion (WAACHS 2007). An Aboriginal
Steering Committee determined the research
direction, methodology and questions, advised
the training of interviewers, interpretation of
results and the formulation of recommendations,
and participated in the translation of the results
with government and communities. The commit-
tee had responsibility to control and maintain the
cultural integrity of survey methods and proc-
esses; employment opportunities for Aboriginal
people; data access issues and communication
of the findings to the Aboriginal and general
community; and appropriate and respectful rela-
tions within the study team with participants,
communities, stakeholders, funding agencies and
governments. Qualitative and quantitative infor-
mation was collected from more than 5000 chil-
dren and families across Western Australia. The
information was analysed by two working parties
with majority Aboriginal members who designed
and monitored the communication, dissem ination
and translation of findings and recommendations.

86 Australian Aboriginal Studies 2010/2
Closing the gaps in and through Indigenous health research Dudgeon
A pilot study was undertaken with remote commu-
nity groups using storyboards, videos, commu-
nity booklets and local community profiles to
determine the most effective and culturally appro-
priate way to communicate the information at a
community level. Importantly, Aboriginal people
had asked for the study to be undertaken to iden-
tify the health and wellbeing of Aboriginal chil-
dren and families in Western Australia compared
with the total state population. The argument
presented by Aboriginal leaders at that time raises
another paradox — that to not undertake research
with Aboriginal people that could help to improve
health outcomes can be as equally unethical as
poor research.
The project conformed to requirements and
protocols for health research with Aboriginal
people and adhered to NHMRC ethical stand-
ards and research guidelines. It was approved by
the Western Australian Department of Health’s
Aboriginal Health Information and Ethics
Committee, as well as the Ethics Committee of
King Edward Memorial and Princess Margaret
Hospitals. The Aboriginal Steering Committee
monitored the adherence to these standards
throughout the project. In addition, two work-
ing groups had responsibility to ensure the effec-
tive and culturally responsive communication,
dissemination and translation of survey results
to communities and stakeholders and policy
makers.
It is difficult to quantify the extent to which the
WAACHS has impacted on health and well being
outcomes overall. However, there are numerous
instances where communities have engaged in
subsequent initiatives because of the WAACHS
findings and recommendations and because they
have ‘ownership’ over and confidence in the
results precisely because they were aware that
Aboriginal people had been extensively involved
in the research from the onset.
Case study 2 : The Kalgoorlie Otitis Media
Research Project: ethical considerations
There had been a call from the community for
a study such as the Kalgoorlie Otitis Media
Research Project: people were concerned about
the potentially negative impact of Otitis Media
(OM) on children’s wellbeing, in particular on
their school performance. The co-ordinator (Elsie
Edwards) of Ngunytju Tjitji Pirni Inc. (NTP,
an Aboriginal Health Service) was chief investi-
gator on the first grant application in 1997 and
Aboriginal investigators were part of subsequent
funding applications. Formal collaboration with
Bega Garnbirringu Health Service Aboriginal
Corporation (BEGA) was established in 1999.
When learning that BEGA had limited access to
ear, nose and throat (ENT) specialists, the NTP’s
ENT specialist offered his services at no cost until
another specialist became available. The NTP
also assisted BEGA in obtaining funding for an
Ear Health Worker and offered parents and chil-
dren transport to ENT clinics.
People were informed about the study through
radio and television interviews, newspaper arti-
cles and face-to-face discussions. Aboriginal and
non-Aboriginal people provided input into the
study design and content of information sheets,
consent forms and questionnaires, which were
developed in line with routine data collection
instruments used by NTP. All research staff pre-
tested all forms and piloted specimen collection
among themselves. This meant they could explain
to future participants what discomfort children
might experience.
Meetings were held with local medical practi-
tioners to explain the purpose of the study, to ask
them to encourage their clients to take part in the
study and to seek their approval to access partici-
pants’ medical records. After 12 months of devel-
oping partnerships with local organisations and
health professionals, the study was endorsed by
the relevant local Aboriginal organisations, lead-
ing to approval from WAAHIEC to conduct the
study.
The research assistants were Aboriginal Health
Workers (AHWs) and nurses who were well known
to the local community. Nurses and AHWs gained
experience in research and played an active role
in the local Ear Health Committee, which aimed
to increase awareness about OM and develop
programs to improve ear health. Being enthusias-
tic about the project themselves, research assist-
ants were able to encourage others to participate
in the study (Lehmann et al. 2007:62–3).
The importance of being critically reflective
of one’s own practice is essential when work-
ing, or undertaking research, in cross-cultural
contexts to ensure that researchers adhere to ethi-

Australian Aboriginal Studies 2010/2 87
Dudgeon Closing the gaps in and through Indigenous health research
cal guidelines for working in Indigenous contexts
(Walker and Sonn 2010). Lehmann et al. (2007)
took on this challenge in their own practice in
the Kalgoorlie OM study. They posed the ques-
tion, ‘How successful were we in conducting this
study in line with the ethical guidelines available
during the planning and recruitment phases of the
study and did we meet up to the more recent crite-
ria and values specified in the 2003 guidelines? ’
(Lehmann et al. 2007). Their reflection on this
topic is summarised in the following quote:
On reflection the study team believed that they
were successful in following the NHMRC
guidelines; they developed good partnerships
with local communities, and participants
actively participated in the research from the
outset. They closely adhered to the guide-
lines regarding consent, confidentiality and
acknowledgement of investigators and partic-
ipants. Even so they felt that they should have
consulted more widely with the communi-
ties when planning the study (Lehmann et al.
2007:68).
They believed the ‘research was potentially useful
to the community’ as local community members
had expressed their concerns about OM and its
consequences. Reduction in the burden of OM
would improve survival of Aboriginal people
as improved hearing leads to better educational
outcomes and quality of life. While members of
the Aboriginal community were participants
from the start, it took more than one year to
develop the research protocol. While it took much
longer than planned for Aboriginal organisa-
tions to consider all aspects of the study, the team
members acknowledged that their input and sense
of ownership contributed to its overall success.
Aboriginal organisations assigned health workers
to the project, participated in focus groups, and
wore T-shirts designed as part of a health aware-
ness campaign aimed at reducing smoking and
enhancing breast feeding.
The project team developed strong partner-
ships, respectful research relationships to achieve
equality, by including all stakeholders in the plan-
ning process and providing them with regular
progress reports. They planned follow-up visits so
that they would not be too disruptive to people’s
lives and ensured reciprocity in the research by
providing hearing screening to all newborns and
the pneumococcal conjugate vaccine (Prevenar™)
to non-Aboriginal children (who were not gener-
ally eligible for this at the time) and regular ENT
follow-up to study participants and their fami-
lies, and arranged prompt surgical intervention if
required. ENT specialist services continue and a
hearing screening program is being developed as
a consequence of the study.
In the spirit of developing true partnerships,
AHWs were initially seconded from NTP or
BEGA to work part-time on the project. However,
they frequently had other commitments and it was
only when there were sufficient funds to employ
a dedicated research assistant, Annette Stokes,
that recruitment of Aboriginal babies increased
and follow-up was more successful. Annette
was supported by the community to take on the
cultural and spiritual responsibility to ensure
the success of the project. The Aboriginal staff
provided cultural security for the study, linking
non-Aboriginal investigators with the Aboriginal
community and increasing their understanding of
how children were living with OM.
The team took responsibility to maintain
confidentiality and to present results to the local
community before publishing or presenting them
outside the local community. The team provided
feedback on the progress and results of the study
to the community, study participants and serv-
ice providers during local social activities and
National Aboriginal and Islander Day Observance
Committee week celebrations and through news-
letters. Steps to transfer the research results using
community-based health promotion and prevent-
ative strategies have been undertaken with the
community to reduce OM within the community
(Lehmann et al. 2007:68).
The reflections by Lehmann et al. (2007) on
their study confirm that using community partic-
ipatory action research and adhering to partici-
patory and ethical practice not only increases
the likely success of the process but increases the
likely improvements in health outcomes. Both case
studies demonstrate how engaging in early and
ongoing consultation contributes to community
ownership, and greater uptake, of research find-
ings and hence greater potential to improve health
outcomes. Both studies established Aboriginal
reference groups, factored in funding and time

88 Australian Aboriginal Studies 2010/2
Closing the gaps in and through Indigenous health research Dudgeon
to develop partnerships and to ensure Aboriginal
participation in all phases of the research, devel-
oped processes to ensure confidentiality of
information and Aboriginal control of the dissem-
ination, communication and translation of results
and management of access to data, and included
appropriate acknowledgment of all Aboriginal
contributions.
These case studies show that it is possible to
adopt a decolonising approach to Indigenous
health research through a commitment to trans-
lating the results at both policy and local commu-
nity levels to support Aboriginal priorities and
interventions to improve health outcomes. In
summary, these case studies confirm that, despite
the many constraints and contextual challenges,
it is possible to conduct rigorous research in genu-
ine partnership with Aboriginal communities and
organisations in order to improve health outcomes
that meet Aboriginal priorities.
Developing culturally competent
researchers
Research has been a powerful part of the colo-
nisation of Indigenous peoples throughout the
world. In Australia Indigenous academics includ-
ing Martin (2008), Moreton-Robinson (2004),
Nakata (2007), Oxenham (1999) and Rigney
(1997, 1999) have raised concerns about owner-
ship of Indigenous knowledges and the role of
research in the process of colonisation. They
urge Indigenous Australians to critically engage
in developing an Indigenist research agenda and
emancipatory research methodologies as part of
that engagement. Rigney (1999:114) summarised
these concerns:
Indigenous Peoples must look to new anti
colonial epistemologies and methodologies
to construct, rediscover, and/or reaffirm their
knowledges and cultures. Such epistemologies
must represent the aspirations of Indigenous
Australians and carry within them the poten-
tial to strengthen the struggle for emancipa-
tion and liberation from oppression.
Oxenham (1999) outlines the core values of
Aboriginal terms of reference as the right of expres-
sion of Indigenous realities through the processes
of deconstruction and reconstruction. Implicit in
this is the view that Aboriginal people have the
right to ‘speak back’ to the historical and contem-
porary (mis)constructions about themselves and
their culture. As well as Aboriginal and Torres
Strait Islander attempts to reclaim and reposition
the representation of Indigenous cultures in their
work, in an effort to re-set the nature and intent
of their relationships with Indigenous peoples,
non-Indigenous scholars need to examine the
concepts of whiteness /power and decolonisation,
as well as the more common understandings of
discrimination, the contribution of research to
Indigenous disadvantage, strategies to re-position
and support Indigenous initiated and led research,
and how they might contribute to Aboriginal and
Torres Strait Islander self-determination.
Dunbar et al. (2003:13) caution that collabora-
tive research methodologies ‘are always activated
within institutional contexts with their attend-
ant political and ideological underpinnings’,
and ‘without a critical awareness…the liberating
potential of the adopted research methodologies
may be diminished as the “research-in-practice”
defaults to the desires of the most powerful’.
They suggest the difficulties in establishing and
maintaining cross-disciplinary research teams
highlight the need for careful preparation and a
commitment to privileging Indigenous voices in
multi-disciplinary research teams.
Conclusion
Historically, Indigenous health research, and
especially epidemiological studies, have reflected
the interests of the dominant population. Despite
their geographical and cultural diversity, key indi-
cators of Indigenous population health have been
aggregated and reported in largely descriptive
and comparative terms which have not necessar-
ily served the interests of Aboriginal and Torres
Strait Islander people. Until recently, very little
research has been undertaken to understand
the complex, multifaceted social determinants
that influence Indigenous health and well-
being outcomes. Increasingly, however, through
the work of the CRCAH, NHMRC and the
WAACHS discussed in the paper, the growing
body of Indigenous research shows that cultur-
ally responsive and inclusive methodologies and
approaches to research which engage Aboriginal
people as active partners in the research can result
in greater uptake of research findings and greater

Australian Aboriginal Studies 2010/2 89
Dudgeon Closing the gaps in and through Indigenous health research
capacity and knowledge of Aboriginal communi-
ties about the relevance and value of the research.
It is also recognised that research and evalu-
ations of interventions and programs that are
working to address Aboriginal health and well-
being questions are essential to closing the gap
(Campbell et al. 2007). This requires researchers
who are competent to work in multidisciplinary
teams and in partnership with culturally diverse
populations. The increasing understanding of the
need to involve Aboriginal people in setting the
research questions and interpreting the results
offers new and exciting possibilities for future
partnerships and ethical practice (Dunbar et al.
2003).
NOTE
1. For a full list of HRECs, see the ‘Ethics commit-
tees’ page of the Indigenous Health Ethics Network
website at <www.indigenoushealthethics.net.au/
hrec>.
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Dr Pat Dudgeon is descended from Bardi people of
the Kimberley in Western Australia. As well as leader-
ship in Indigenous higher education, she has had signif-
icant involvement in psychology and Indigenous issues
for many years. She has many publications in this area
and is considered one of the ‘founding’ people in
Indigenous people and psychology. She is the current
Chair of the Australian Indigenous Psychologist’s
Association and a member on the Public Interest
Advisory Group of the Australian Psychological Society
(APS), and was awarded the grade of Fellow in the APS
in 2008. Currently, she is a research fellow and an asso-
ciate professor at The University of Western Australia,
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Torres Strait Islander mental health and wellbeing prin-

Australian Aboriginal Studies 2010/2 91
Dudgeon Closing the gaps in and through Indigenous health research
ciples and practice (2010) and Working With Indigenous
Australians: A handbook for psychologists (2000).
<pat_dudgeon@optusnet.com.au>
Kerrie Kelly is a psychologist who has worked at a
national level in the area of rural, remote and Indigenous
health for more than a decade. Her main focus has been
on workforce sustainability and the development of
population health models to prevent job-related trauma
and burnout among remote health practitioners, includ-
ing Indigenous health practitioners. Kerrie is one of a
small number of psychologists who has been mentored
by Indigenous Elders to develop cultural competence in
the area of social and emotional wellbeing, including
the impact of forcible removal (the Stolen Generations).
Currently she is the Project Officer for the Australian
Indigenous Psychologists Association. She was the key
researcher and lead author of a discussion paper with
P Dudgeon, B Glaskin and G Gee, Living on the Edge:
Social and emotional wellbeing and risk and protec-
tive factors for serious psychological distress among
Aboriginal and Torres Strait Islander people (2009).
<KerrieAKelly@bigpond.com>
Associate Professor Roz Walker has more than 25
years of experience as a researcher and educator work-
ing with Aboriginal communities, building local capacity
within both Aboriginal and non-Aboriginal organisa-
tions. She has worked in Aboriginal education in teach-
ing, curriculum development, academic co-ordination,
research and evaluation. She has extensive experience in
translating research into policy and practice. Most recent
examples include her involvement in communicating and
disseminating the Western Australian Aboriginal Child
Health Survey through Western Australia to communi-
ties and key stakeholder groups and implementing the
Australian Early Development Index across the Pilbara.
A key project has been the Staying on Track substance
use reduction project funded through BHP Billiton
Iron Ore Health Partnership with Telethon Institute for
Child Health Research (TICHR). Roz recently co-edited
and contributed to a book, Aboriginal and Torres Strait
Islander Mental Health and Wellbeing Principles and
Practice (2010). Roz Walker is a Chief Investigator on
an NHMRC Centre for Research Excellence in Aboriginal
Health and Wellbeing at TICHR. Her main areas of
interest include community-based participatory action
research and cultural competence.
<rozw @ichr.uwa.edu.au>

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