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Measuring the health and wellbeing impacts of cultural camps among Aboriginal adults: preliminary evidence from the Gaawaadhi Gadudha Research Collaborative

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Background Aboriginal and Torres Strait Islander peoples’ have sustained their cultural practices for over 60,000 years which fundamentally impacts their health and wellbeing. Recent literature emphasizes cultural connection as a contributor to good public health, yet the mechanisms through which cultural engagement promotes health and wellbeing remain underexplored. This study investigates the health and wellbeing outcomes associated with Aboriginal peoples’ participation in cultural camps in New South Wales (Australia), focusing on the role of cultural determinants of health. Methods This cohort study, part of the larger Gaawaadhi Gadudha Research Collaborative, examines the impact of camp attendance on health indicators among Aboriginal adults. Participants (N = 43) completed surveys assessing individual cultural health, access to cultural resources, resilience, and health-related quality of life pre and post camp. Paired-samples t-tests and Wilcoxon related samples signed-rank tests were employed to analyze changes. Findings Participants reported high engagement in cultural activities and positive experiences at camps. Post-camp responses indicated significant improvements in cultural health, including increased pride in cultural identity, knowledge of traditions, and connections to Country and community. However, measures of resilience and health-related quality of life showed no reliable changes. Interpretation The findings suggest that camps play a crucial role in enhancing cultural health among Aboriginal peoples, reinforcing the importance of knowledge of cultural determinants of health. This study underscores the need for further research to explore the long-term impacts of cultural engagement on health and wellbeing and highlights the potential of cultural camps as a model for health promotion initiatives within Aboriginal communities. Funding This study was funded by the Australian Government’s Medical Research Future Fund (MRF2009522).
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Measuring the health and wellbeing impacts of cultural camps
among Aboriginal adults: preliminary evidence from the
Gaawaadhi Gadudha Research Collaborative
Brooke Brady,
a
,
b
,
c
,
Anthony B. Zwi,
f
Jonathan Kingsley,
g
Michelle OLeary,
d
,
e
Nina Serova,
d
Stephanie M. Topp,
h
,
f
Brett J. Biles,
e
,
i
Ted Fields,
d
,
e
Warren Foster,
d
,
e
and Aryati Yashadhana
d
,
e
,
f
a
School of Psychology, University of New South Wales, Sydney, NSW, Australia
b
Neuroscience Research Australia, Sydney, NSW, Australia
c
UNSW Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
d
Centre for Primary Health Care & Equity, University of New South Wales, Sydney, NSW, Australia
e
School of Population Health, University of New South Wales, Sydney, NSW, Australia
f
School of Social Sciences, University of New South Wales, Sydney, NSW, Australia
g
School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
h
College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
i
Deputy Vice-Chancellor Indigenous Division, University of New South Wales, Sydney, NSW, Australia
Summary
Background Aboriginal and Torres Strait Islander peopleshave sustained their cultural practices for over 60,000 years
which fundamentally impacts their health and wellbeing. Recent literature emphasizes cultural connection as a
contributor to good public health, yet the mechanisms through which cultural engagement promotes health and
wellbeing remain underexplored. This study investigates the health and wellbeing outcomes associated with
Aboriginal peoplesparticipation in cultural camps in New South Wales (Australia), focusing on the role of cultural
determinants of health.
Methods This cohort study, part of the larger Gaawaadhi Gadudha Research Collaborative, examines the impact of
camp attendance on health indicators among Aboriginal adults. Participants (N = 43) completed surveys assessing
individual cultural health, access to cultural resources, resilience, and health-related quality of life pre and post camp.
Paired-samples t-tests and Wilcoxon related samples signed-rank tests were employed to analyze changes.
Findings Participants reported high engagement in cultural activities and positive experiences at camps. Post-camp
responses indicated signicant improvements in cultural health, including increased pride in cultural identity,
knowledge of traditions, and connections to Country and community. However, measures of resilience and
health-related quality of life showed no reliable changes.
Interpretation The ndings suggest that camps play a crucial role in enhancing cultural health among Aboriginal
peoples, reinforcing the importance of knowledge of cultural determinants of health. This study underscores the need
for further research to explore the long-term impacts of cultural engagement on health and wellbeing and highlights
the potential of cultural camps as a model for health promotion initiatives within Aboriginal communities.
Funding This study was funded by the Australian Governments Medical Research Future Fund (MRF2009522).
Copyright © 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Keywords: Indigenous; Cultural determinants of health; Land; Resilience; Healing
Introduction
Continuity in Aboriginal and Torres Strait Islander
(herein Aboriginal) cultures has been present for over
60,000 years; and is ever evolving.
13
Aboriginal models,
frameworks and concepts of health are deeply connected
to culture, Country (i.e., land), kin, history, protocols,
language, identity, and community.
3
Although an
emergent body of literature highlights cultural
*Corresponding author. School of Psychology, University of New South Wales, Sydney 2052, Australia.
E-mail address: b.brady@unsw.edu.au (B. Brady).
The Lancet Regional
Health - Western Pacic
2024;52: 101200
Published Online 10
November 2024
https://doi.org/10.
1016/j.lanwpc.2024.
101200
www.thelancet.com Vol 52 November, 2024 1
Articles
connection as a public health preventative measure in
Aboriginal populations,
35
there is a lack of evidence
identifying how and what mechanisms lead to these
health and wellbeing benets.
4,68
The concept of the
cultural determinants of health allows us to better un-
derstand this relationship. Cultural determinants of
health are dened by the National Institute of Aboriginal
and Torres Strait Islander Health Research (Lowitja
Institute) as: promot[ing] a strength-based perspective,
acknowledging that stronger connections to culture and
country build stronger individual and collective identities, a
sense of self-esteem, [and] resilience.
9
In this paper, we explore the relationships between
Aboriginal peoplesengagement with cultural camps
(herein camps) on Country, and several indicators of
health and wellbeing, including individual connection to
culture, access to cultural resources, resilience, and
health-related quality of life. Culture and Country are
intimately intertwined for Aboriginal peopleshealth
and wellbeing.
1012
Specic to Australia, this is because
connection to Country is unbroken for Aboriginal peo-
ples and refers to a deep, intimate, holistic, complex,
localized, and reciprocal relationship which includes ele-
ments of the land, sea, waterways, sky, stars, and living and
nonliving entities Country is more than something you
just see as a physical entityit is a living system tied to
language, identity, and customs; it is not static or frozen in
time, incorporating the social, spiritual, and cultural link-
ages of Aboriginal and Torres Strait Islander peoples.
3
Country teaches, speaks, and connects communities in
a reciprocal relationship with animals, plants, rocks,
water and sea through time and space and is passed on
through actions, activities and protocols like songlines,
language, re, food and medicine, seasonal calendars
and ceremony.
3,4,13
A separate but related body of work
has also explored cultural connection and connection to
Country in the context of Aboriginal constructs of
resilience,
1416
rening conceptualisations of the role of
culture and Country in promoting health and resilience
and developing tools to evaluate those links. Very
limited research has been conducted examining the
effectiveness of practices and programs designed to
strengthen these links. In one notable example Dobia
et al.
17
measured the effects of Aboriginal GirlsCircles
on participantsresilience, connectedness, self-concept
and cultural identity, evaluating the relative effective-
ness of various components of the program and
reporting positive impacts. However, there remain sig-
nicant knowledge gaps in relation to the measurable
health impacts of practices and programs designed to
promote connectedness to culture and Country, such as
camps.
The cultural camps
This study centres on three camps, held, respectively, on
Yuwaalaraay, Gamilaraay, and Yuin-Djirringanj Country
in New South Wales in 2022. The camps involve expe-
riences with cultural lore, traditional languages, and
Research in context
Evidence before this study
Prior to this study, the evidence for cultural connection as a
contributor to health and wellbeing was largely conceptual or
qualitative.
Added value of this study
The added value of this study lies in its empirical exploration
of the health and wellbeing impacts of attending cultural
camps among Aboriginal peoples within the Australian
context. This study employs a comprehensive evaluation
protocol to quantitatively assess changes in individual cultural
health, access to cultural resources, resilience, and health-
related quality of life pre- and post-camp attendance.
Furthermore, the study has value for policy and practice,
offering empirical support for the role of cultural camps as
effective public health programs that can enhance cultural
connection, sense of identity, and wellbeing. This evidence is
crucial for informing health policies and practices that
prioritize cultural determinants and strength-based
approaches.
Implications of all the available evidence
Overall, the study ndings combined with existing evidence
highlight the critical role of cultural connection as a
determinant of health and wellbeing among Aboriginal
peoples. The implications of this evidence for policy and
practice include, rstly, recognition of the need to integrate
cultural determinants in public health strategies and health
programming, highlighting the importance of culture,
Country, and community in promoting health and wellbeing.
This includes the development and support of culturally
centred programs, such as cultural camps, that facilitate
engagement with culture and Country. Secondly these
research insights aim to increase policy support and
resourcing for Aboriginal-led initiatives that strengthen
cultural connection. There are also implications for future
research including: i) investing in longitudinal research to
assess the long-term impacts and sustainability of health
benets derived from cultural engagement and participation
in cultural camps; and ii) investigation of the mechanisms
through which cultural connection inuences health
outcomes. This might include exploration of whether specic
aspects of cultural engagement are most benecial and
determining if and how they interact with other determinants
of health.
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connection to and understanding of cultural landscapes
(including learning to identify traditional foods and
medicines). The camps are regularly organised by cul-
tural knowledge holders who are Aboriginal custo-
dians of both Country and immaterial aspects of culture,
such as language, stories and law outside of this
research. The camps form part of the knowledge
holderswork that supports the continuation of culture.
They welcome Aboriginal people from all nation groups.
Cultural knowledge holders invite camp participants
through their networks, via advertisements and word-of-
mouth, in person and on social media. They welcome
Aboriginal and Torres Strait Islander people from all
nation groups. Families are invited, including non-
Aboriginal family members. The camps, which are be-
tween three and ve days in length, are held on Country,
in proximity to sites that are sacred to the relevant lan-
guage group. For example, Dharriwaa, where the
Yuwaalaraay camp is held, is a traditional meeting place,
which holds sites connected to signicant ancestral
stories. Women, men, and families are invited to camp
separately (participants can choose their camp) and all
meet for mealtimes and for cultural involvement,
including gender specic activities. By facilitating
connection to cultural landscapes (e.g., physical sites
minimally impacted by colonisation, including natural
and sacred sites protected from urbanisation or devel-
opment)
3,18
and transgenerational and intercultural
knowledge exchange, the camps aim to encourage cul-
tural and kinship connection, decolonization, and heal-
ing for participants. Fig. 1 shows images from the
Dhariwaa (Yuwaalaraay) and Yuin (Yuin-Djirringanj)
camps.
The current study aims to honour Aboriginal
models, frameworks, and concepts of health by
providing initial evidence for the health and wellbeing
impacts of attending cultural camps. We do so through
the lens of a strength-based approach which seeks: “… to
move away from the traditional problem-based paradigm
and offer a different language and set of solutionsthat
centre Aboriginal cultures, and ways of being, knowing,
and doing.
3
Specically, we aim to explore pre- and post-
camp quantitative indicators of individual cultural
health, including access to cultural resources, individual
and relational resilience, and health-related quality of
life of Aboriginal adults who attended camps. This study
extends previous international work
19
by exploring the
health impacts of attending cultural camps using a more
extensive evaluation protocol than previously under-
taken in the Australian context.
Methods
Study design
This cohort study is part of the Gaawaadhi Gadudha
Research Collaborative. More detailed information
regarding the broader study conceptualisation, gover-
nance structure and methodology can be found in the
projects study protocol paper.
8
Nonetheless, in the
following paragraphs we provide a brief overview of
each of these factors as relevant to the aims of the
current study. Companion papers in the series explore:
the need to rethink the health gapbetween Aboriginal
and non-Aboriginal populations as instead a need to
strengthen cultural connection
20
;theconceptofcul-
tural health through a narrative review of the litera-
ture
21
; and how health and wellbeing are
phenomenologically connected to cultural practices,
foods, medicines, languages, and Country using qual-
itative data collected at cultural camps.
22
The current
paper reports specically on pre-to post-camp quanti-
tative data exploring the impact of camp attendance on
a range of health and wellbeing indicators. Ethics
approval was obtained from the Aboriginal Health and
Medical Research Council (#1851/21).
Cultural governance
The Gaawadhi Gadudha Research Collaborative (herein
Research Collaborative), which this study is a part of,
Fig. 1: Images taken at Dhariwaa camp (left) and Yuin camp (right).
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was conceptualised in close partnership with traditional
cultural knowledge holders (TF, MO, WF) from
Yuwaalaraay, Gamilaraay, and Yuin Aboriginal Nations
of New South Wales (NSW) Australia. More information
on the Collaborative can be found in the qualitative
article in this collection (Yashadhana et al., 2024). The
Gaawaadhi Gadudha Cultural Governance Group
(herein Cultural Governance Group), composed of these
knowledge holders, led decision-making in their
respective locations in relation to research governance,
design, implementation, data collection, data analysis,
and dissemination. As described in the study protocol,
8
the cultural health surveys reported in the present study
were developed with oversight from the Cultural
Governance Group, to ensure all content was culturally
appropriate and meaningful to the study aims.
Participants
Aboriginal adults aged 18 years or older were invited to
participate in this research by completing at least one
cultural health survey. A total of 320 adults consented to
and completed at least part of the pre-camp survey. Of
those, 166 indicated that they were intending to partic-
ipate in an upcoming camp, and 154 indicated that they
were not. We refer to these samples as the camp cohort
and the comparative cohort, respectively. The camp
cohort were invited to participate via email after they
had registered to attend a camp, and some were invited
to participate at the beginning of the camp before ac-
tivities commenced. The comparative cohort was
sampled from the same regions in which the camps
took place. This study does not report on data from the
comparative cohort. A total of 65 participants consented
to and completed at least part of the post-camp survey.
Some of those respondents had not completed a pre-
camp survey. As the present study is interested in pre-
to post-camp differences, we report only data from
those who i) participated in a camp and ii) completed
both the pre- and post-camp surveys (N = 43). This
sample size is sufciently powered to detect small-to-
moderate effect sizes in paired-samples tests, with
alpha (two-tailed) = 0.05 and power of 0.80.
23
More de-
tails of sample characteristics are reported in the results
section.
Procedure
Community-based researchers were available to all par-
ticipants to explain the study thoroughly and privately
prior to participants providing informed consent. Those
who consented had the choice of completing each sur-
vey on their own, or with assistance from a research
team member. The survey was designed using Qual-
trics
24
and data were collected electronically using a
personal device or provided tablet. Data collected
included personal characteristics, cultural identities and
responsibilities, camp experiences, individual cultural
health, access to cultural resources, resilience, and
health-related quality of life. The pre-camp survey took
approximately 40 min to complete and was adminis-
tered within two weeks of attending a cultural camp.
The post-camp survey took approximately 30 min to
complete and was administered during the nal hours
of each cultural camp. Aside from eligibility questions
(age, Aboriginality), all survey questions were optional,
and respondents could skip any item they did not wish
to answer. The pre- and post-camp surveys are included
in the Supplementary Materials. Respondents received a
$40 AUD grocery voucher for their time after
completing each survey.
Outcomes
Personal characteristics
Participants were asked to report their age in years,
gender identity (male,female,non-binary or third
gender,I use another term(text entry), prefer not to
say), main source of income (full time employment,
part time employment,casual employment,Cen-
trelink (social welfare) payments,I dont have an in-
come), housing situation (living in own home,living
in rented home,living in affordable housing,living
in public housing,living in Aboriginal housing,
living temporarily with friends or family,houseless)
whether they were currently living on their own Country
(yes,no), and the preferred term they used when
describing their cultural identity. Participants could
select from a range of identities or type in their
preferred identity using open text. The survey also
collected some additional personal and cultural charac-
teristics not reported here.
Overall camp experience and activities
Participants were asked to rate their overall experience
at camp using a sliding scale from 1 (extremely negative)
to 100 (extremely positive). They were asked if they
would be interested in attending the next camp gath-
ering, with response options including yes,noor
maybe. They were also asked to indicate how much
time they felt they spent on a range of activities at camp,
using a Likert-type scale from 1 (none)to5(a great
deal).
Individual and collective access to culture, cultural knowledge,
and resources (cultural health)
Repeated measures. This study included repeated
measures of cultural health that were completed both
pre- and post-camp. Individual connection to culture
was measured using a combination of selected items
from the Mayi Kuwayu Survey,
25
and the Cultural
Connectedness Scale.
26
Items were selected based on
their relevance to the study aims
8
and were discussed at
length with the Cultural Governance Group. Some
items were modied to suit the local context. For
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example, instead of using the term Aboriginal, the
participants self-identied cultural group was piped
into questions. Items around individual and collective
access to culture were developed by the Gaawaadhi
Gadudha Research Collaborative and Cultural Gover-
nance Group and drew on the experience and previous
work on cultural heritage previously undertaken by one
of the knowledge holders (TF).
Stand-alone measures. As cultural health is of central
interest in this study, we also included a series of stand-
alone items which were designed to detect meaningful
changes in aspects of cultural health related to attending
the camps which may not be detectable using the
measurement approach above. For example, we antici-
pated that at least a portion of the sample would rate at
the highest ends of Likert-type scales on cultural health
indicators prior to the camps, leaving no capacity for
measures to reect potential positive change following
the camps. An example stand-alone item is How did
your knowledge of history, traditions and customs
change as a result of attending the Camp?. The 5-point
response scale (decreased a lot,decreased a little,
no change,increased a little,increased a lot) was
designed to allow for both positive and negative changes
in cultural health indicators.
Resilience
This study included two measures of resilience: an 18-
item Adaptation of the Aboriginal Resilience and Re-
covery Questionnaire (ARRQ)
14,27
and the 10-item
Connor-Davidson Resilience Scale (CD-RISC).
28
The
original ARRQ was developed through a process of
consultation and collaboration with Aboriginal adults
and was specically designed to be culturally appro-
priate and sensitive to the experiences of Aboriginal
people in Australia. Permission was granted from the
author of the ARRQ
14,27
to create an adapted version of
selected survey items to be used in the study. Our
adaptation (developed by AY and BB with iterative
feedback from the Cultural Governance Group) consists
of 18 items grouped into two subscales: sources of
personal strength (8 items) and sources of relational-
community-cultural strength (10 items). Among the
current sample, responses to the pre-camp survey were
used to calculate scale reliability which was found to be
very good for both the personal strengths (Cronbachs
α= 0.875) and the relational-community-cultural
strength subscales (Cronbachsα= 0.873). Items
within each subscale, item scores and item-total statis-
tics are presented in Supplementary Table S1.
The 10-item CD-RISC
28
is a widely used measure of
individual resilience. The scale consists of 10 items,
each rated on a 5-point Likert-type scale ranging from 1
(not true at all) to 5 (true nearly all the time). Example
items include I am able to adapt when changes occur
and I tend to bounce back after illness, injury, or other
hardships.Item scores are summed to create a total
resilience score ranging from 10 to 50, with higher
scores indicating greater resilience. This measure has
been used in previous research among Aboriginal
adults
14
and demonstrated good reliability in the current
sample based on pre-camp survey responses (Cron-
bachsα= 0.883).
Health-related quality of life and self-rated health
The EQ-5D-5L
29
is a self-report measure of health-
related quality of life. The measure includes a visual
analogue scale, which allows individuals to rate their
overall level of health-related quality of life on a scale
from0to100,withhigherscoresindicatingbetter
overall health-related quality of life. It also assesses an
individuals health status across ve dimensions of
health, including: mobility, self-care, usual activities,
pain/discomfort, and anxiety/depression. Each
dimensionismeasuredonave-point scale, ranging
from 1 no problemsto 5 extreme problems.Higher
scores indicate poorer health status. The EQ-5D-5L has
been shown to be a suitable measure of health-related
quality of life among a large sample of Aboriginal
people.
30
Statistical analysis
Descriptive statistics were used to summarize the
sample characteristics and stand-alone items exploring
the impact of attending camp on cultural health.
Continuous variables (e.g., age) were described using
means and standard deviations, while ordinal or cate-
gorical variables (e.g., gender, housing status, camp
impacts) were described using frequencies and per-
centages. As outlined in the study protocol,
8
we aimed
to conduct regression analyses to explore pre-to post-
camp differences in health indicators after controlling
for possible covariates such as age or gender. However,
signicant drop-off in the completion rates from the
pre-to post-camp surveys resulted in a smaller than
anticipated sample size, precluding the capacity to
include covariates in statistical models (discussed later
in this paper). As such, we used paired-samples t-tests
(for continuous measures) and Wilcoxon related sam-
ples signed-rank tests (for ordinal measures) to explore
pre-to post-camp differences in cultural health in-
dicators, resilience, and health-related quality of life.
Pairwise deletion was used to handle missing data,
because complete pre-post data was important for
many of the planned analyses. All statistical analyses
were computed using SPSS Version 26.
31
Interpreta-
tion of results was guided by the Cultural Governance
Group.
Role of the funding source
The funder of the study had no role in study design, data
collection, data analysis, data interpretation, or writing
of the report.
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Results
This paper reports on data from 43 Aboriginal adults (29
females, 14 males; mean age = 44.3 years, age range
1974 years) who completed both the pre- and post-
camp surveys. Before attending the camp, most at-
tendees spent at least a little time on a range of cultural
activities, see Supplementary Table S2. Sample charac-
teristics are described in Table 1.
Attendeesperceptions of the amount of time spent
on a range of cultural activities at camp are summarised
in Table 2, which indicated engagement across the full
range of activities surveyed.
Overall, attendees rated their experience at camp as
extremely positive, with an average rating of 93.85/100
(SD = 8.27, range 66100). Responses were clustered at
the highest end of the reporting scale, with 46.2% of
people rating their experience 100/100 and 82.7%
providing a rating of 90/100 or higher. 95.3% of people
said they would like to attend the next cultural camp
offered, and the remaining 4.7% said Maybe.
Wilcoxon related samples signed-rank tests were
used to compare ratings of specic cultural health in-
dicators from pre-to post-camp. Table 3 shows item
response frequencies and tests of pre-to post-camp
differences. We did not detect any statistically signi-
cant differences in average responses to cultural health
items across time, with mean scores on the high end of
the response scale at each timepoint.
However, stand-alone post-camp questions revealed
strong positive impacts of attending camp on all cul-
tural health indicators we surveyed. As shown in Fig. 2,
83.7% of people experienced an increase in their own
sense of pride in their cultural identity, and 69.8% an
increase in their perceived importance of being rec-
ognised as Aboriginal. In terms of cultural knowledge,
93% of people said they increased their knowledge of
history, traditions, and customs, 87.5% increased their
knowledge of physical sites of spiritual or cultural
signicance, 68.3% increased knowledge of traditional
foods, 70.7% increased knowledge of traditional med-
icines, 77.5% increased knowledge and access to cul-
tural resources, and 85% reported an increase in
knowledge of important cultural stories. When asked
about the impact of camp attendance on perceived
connections, 90% reported increased connection to
other people, 72.1% reported increased connection to
their own Mob or Nation, 86% reported increased
connection to Ancestors, and 85% reported an
increased connection to Country. 85.4% of people re-
ported that they heard or learned new Aboriginal words
or language at camp, and 68.3% reported that they
shared words or language they knew with others.
Remarkably, 97.5% of people indicated that they
experienced a sense of healing as a direct result of
attending the camp.
Paired-samples t-tests were used to compare scores
on the CD-RISC and ARRQ before and after attending a
cultural camp. The was no difference in the average CD-
RISC score before (M= 27.85, SD = 6.15) and after
camp (M= 28.85, SD = 7.36), t(38) = 1.05, 95% CI
[2.99, 0.99], p= 0.316, Cohensd
av
= 0.15, 95%CI
[0.12, 0.42].
Adapted ARRQ total scores were not signicantly
different pre- (M= 56.59, SD = 9.40) and post-camp
(M= 58.85, SD = 7.99), t(38) = 1.79, 95% CI [4.80,
0.29], p= 0.081, Cohensd
av
= 0.26, 95%CI [0.01, 0.54].
Neither were ratings on the Sources of Personal
Strength subscale pre-camp (M= 25.54, SD = 4.48)
compared to post-camp (M= 26.23, SD = 3.77),
t(38) = 1.22, 95% CI [1.84, 0.46], p= 0.23, Cohens
d
av
= 0.17 95%CI [0.09, 0.43].
However, we found evidence of a marginally signif-
icant increase in ratings on the Sources of Relational-
Community-Cultural Strength subscale following camp
attendance, t(38) = 2.03, 95% CI [3.12, 0.01],
p= 0.049. The average pre-camp score was M= 31.05
(SD = 5.67), and the average post-camp score was
M= 32.62 (SD = 5.03). The effect size for the difference
appeared to be small, Cohensd
av
= 0.29, 95%CI
[.02, 0.53]. The wide condence interval suggests that
we cannot rule out that this effect is either very marginal
Variable Response n%
Preferred description of own cultural identity Aboriginal 13 30.2
Bigambul and Gomeroi 2 4.6
Birrbay and Dhanggati 1 2.3
First Nations 4 9.3
Gamilaraay 15 34.9
Indigenous 1 2.3
Kooma 1 2.3
Marra 1 2.3
Yuin 3 7
Yuwaalaraay 1 2.3
Yuwaalaraay and Gamilaraay 1 2.3
Camp attended Dharriwaa (Yuwaalaraay Country) 22 51.2
Gomeroi (Gamilaraay Country) 9 20.9
Yuin (Yuin-Djirringanj Country) 12 27.9
Currently living on own Country Yes 20 46.5
No 23 53.5
Main source of income Full time employment 15 34.9
Part time employment 8 18.6
Casual employment 3 7
Centrelink payments 16 37.2
I dont have an income 1 2.3
Housing situation Living in a home I own 12 27.9
Living in a home I rent privately or
through a real estate
17 39.5
Living in affordable housing 2 4.7
Living in public housing 2 4.7
Living in Aboriginal housing 7 16.3
Living temporarily with family or friends 3 7
Table 1: Self-reported characteristics of cultural camp attendees (N= 43).
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(at the low end of the condence interval) or moderate
in strength (at the high end of the condence interval).
A paired-samples t-test was used to compare average
overall subjective health ratings pre- and post-camp.
There was no statistical difference between pre-camp
(M= 72.18, SD = 15.67) and post-camp health ratings
(M= 75.13, SD = 17.24), t(39) = 1.00, 95% CI [8.92,
3.02], p= 0.324, Cohensd
av
= 0.18, 95%CI [0.16, 0.53].
Wilcoxon matched-pair signed-rank tests were used to
compare subjective ratings of specic aspects of health-
related quality of life, including mobility, self-care, usual
activities, pain, and anxiety/depression symptoms. As
shown in Table 4, there were no signicant differences
in specic health-related quality of life ratings before
and after the cultural camps, with most respondents
indicating little to no difculty in each domain.
This preliminary study was insufciently powered to
explore the impact of camp attendance on outcomes
separately for men and women. However, following
guidance from our Cultural Governance Group and to
promote transparency, we provide descriptive data
separately for men and women in the Supplementary
materials (see Supplementary Tables S3S10).
Supplementary Table S11 displays exploratory bivariate
associations between primary study outcomes measured
both pre- and post-camp and three potential covariates
of interest: age, gender (men, women), and living on
own Country status (yes, no). These covariates were not
sufciently related to study outcomes to contribute
meaningfully to exploratory regression analyses.
Sensitivity analysis
We are aware that pairwise deletionused in this study
to account for missing datamay yield biased results.
Therefore, we conducted sensitivity analysis by using
multiple imputations for missing parametric data and
re-running analyses to examine consistency of results.
Overall, 47.51% of variables, 18.6% of cases and 3.32%
of values had missing data. The highest percentage of
missing data (14%) was observed for questions pre-
sented at the end of the post-camp survey. The pattern
of missing values suggested that the values was missing
Thinking about your time spent at camp, how much time did you spend: Response, n(%)
None A little bit A fair bit A lot A great deal
With someone who has cultural knowledge (e.g., Elder or knowledge holder) 0 (0%) 4 (9.5%) 14 (32.6%) 9 (21.4%) 15 (35.7%)
Learning and using knowledge from Aboriginal law/lore 1 (2.4%) 10 (24.4%) 9 (22%) 10 (24.4%) 11 (26.8%)
Getting or eating bush tucker (traditional foods and shing) 6 (14.3%) 16 (38.1%) 8 (19%) 6 (14.3%) 6 (14.3%)
Learning culture, kinship, and respect 0 (0%) 4 (9.3%) 11 (26.2%) 14 (33.3%) 13 (31%)
Making art, music, paintings 1 (2.4%) 10 (23.8%) 15 (35.7%) 9 (21.4%) 7 (16.7%)
Passing on cultural knowledge 2 (4.9%) 12 (29.3%) 16 (39%) 4 (9.8%) 7 (17.1%)
Contributing to the camp (e.g., by helping, sharing, healing) 0 (0%) 8 (19%) 12 (28.6%) 8 (19%) 14 (33.3%)
Receiving Aboriginal healing methods (traditional healers, bush medicines) 7 (16.7%) 17 (40.5%) 9 (21.4%) 4 (9.5%) 5 (11.9%)
Table 2: Amount of time spent at camp on specic cultural activities.
Item Pre-camp Post-camp Related-Samples Wilcoxon
Signed Rank Test
nNot at
all
A little
bit
A fair
bit
A
lot
nNot at
all
A little
bit
A fair
bit
A
lot
Z SE Std Z p
I feel proud to be Aboriginal
a
. 43 0 1 0 42 43 0 1 1 41 0.00 0.50 1.00 0.317
How important is it for you to be recognised as an Aboriginal
a
person? 43 0 2 11 30 43 0 2 6 35 32.50 8.01 1.25 0.212
I have spent time trying to nd out more about being Aboriginal
a
, such as the
history, traditions, and customs.
43 0 11 16 16 43 1 9 13 20 136.00 26.57 0.77 0.440
I feel a strong attachment towards my Aboriginal
a
Mob/Nation. 43 0 1 15 27 42 0 1 15 26 60.00 15.91 0.00 1.000
I feel a connection to my ancestors. 43 0 4 14 25 43 0 3 12 28 114.00 22.28 0.85 0.394
I am condent in speaking my language or words
b
25 3 15 5 2 26 4 14 4 4 33.00 8.70 0.63 0.527
It is important that I use my language or words
b
26 0 2 14 10 26 1 2 10 13 28.00 8.02 0.69 0.493
I feel good when I use my language or words
b
25 0 1 7 17 26 0 1 8 17 27.50 8.70 0.00 1.000
I am interested in keeping my language strong
b
26 0 1 1 24 27 0 0 5 22 6.00 3.35 0.45 0.655
My family is interested in keeping my language strong
b
27 0 4 6 17 27 0 5 7 15 8.00 5.29 1.13 0.257
My community is interested in keeping language strong
b
27 0 3 7 17 27 1 2 13 11 21.00 12.12 1.48 0.138
a
Piped text was used in both the pre- and post-camp survey to replace the word Aboriginalabove with each individuals preferred cultural identity term.
b
Only respondents who indicated that they knew
at least a little Aboriginal or Torres Strait Islander words or language(s) completed these questions, reected by smaller sample sizes for these comparisons.
Table 3: Pre-to post-camp tests of differences in cultural health and language indicators.
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at random (MAR). SPSS was used to impute missing
data for parametric tests using a fully conditional spec-
ication approach and ve iterations. Analyses were
then re-run comparing the output of the observed data
to the combined imputed data following Rubins rule.
As shown in Supplementary Table S12, the mean dif-
ferences for t-tests computed with pooled imputed data
were consistent with those obtained using pairwise
deletion. The only difference was that the aARRQ total
score emerged as marginally signicantly higher post-
camp compared to pre-camp following multiple impu-
tation (p = 0.048). Multiple imputation was not used to
impute data for non-parametric tests as non-parametric
data does not have variances that are properly weighted
to allow for imputation. Therefore, only complete-case
data is reported for Wilcoxon signed-rank tests in the
main results section above.
Discussion
The connections between Country, culture, and health
and wellbeing among Aboriginal peoples have been well
described and conceptualised.
3,8,12
Previous studies have
identied culture as a protective factor in Aboriginal
health and wellbeing.
3234
However, measuring the
impact of meaningful and culturally centred initiatives
that address inequitable health outcomes among
Aboriginal peoples in Australia has received limited
attention. This has contributed to the gap between
empirical research and tangible and benecial change.
35
Our work has built on established insights and sought to
develop empirical evidence regarding the value and
impact of a particular initiative focused on enhancing
health and wellbeing through strengthening connec-
tions with Country and culture. While the sample size
was smaller than anticipated, we have identied a range
of positive outcomes that warrant attention and will be
explored in further publications and initiatives.
Specically, little research on cultural camps as a
platform and mechanism to improve Aboriginal health
and wellbeing exists in the Australian context.
17,36
Our
study is the rst in the Australian context to measure the
impact of cultural camp attendance among Aboriginal
peoples. In the international context, there are a few
peer-reviewed studies that have measured the impact of
attending an indigenous cultural camp on participant
health or wellbeing.
19,26,37
Redvers and colleagues
19
explored the benet of attending an urban land-based
Fig. 2: Perceived impacts of attending camp on cultural health indicators (N= 43).
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8 www.thelancet.com Vol 52 November, 2024
healing camp among Indigenous people at high risk of
homelessness and substance use living in Yellowknife,
Canada. Using a two-item feedback survey, they found
that people who spent time at the camp rated their
emotional wellbeing as better when leaving camp
compared to when arriving at camp. Their preliminary
study did not collect data on any other indicators of
health or wellbeing. Our Research Collaborativewhich
centres existing, Aboriginal-led and run cultural camps
on Country at three locations in New South Wales
involved far more extensive evaluation of the health and
wellbeing impacts of attending a cultural camp within a
sample of Aboriginal adults in Australia (see pre- and
post-camp surveys reported in the Supplementary
materials). Importantly, and as expected, we found
strong support for the format of camps as engaging (by
virtue of offering participation in a wide range of cul-
tural activities), enjoyable, and benecial. Indeed, re-
spondents indicated strong participation in the full
spectrum of cultural activities we surveyed. Our results
have provided clarity to the concept of cultural health,
by evidencing measurable indicators that reect how
previously abstract notions such as connectedness to
culture, Country, and mob, and strength in Aboriginal
cultural identity, act as protective factors in health and
wellbeing. The results presented in this paper are
mirrored in qualitative results that reect the impor-
tance of cultural health through the voices of camp at-
tendees.
22
We also acknowledge that capturing data is
always imperfect and cannot account for the many other
ways in which culture is shared and expressed at camps
outside of what was asked about in the survey. Percep-
tions of the camp were exceptionally positive and there
was almost universal interest in attending again, sug-
gesting that this is a very promising format.
Through the process of conducting this study, and in
discussion with the Cultural Governance Group who
oversee this work, we gained valuable insight into
measurement approaches to health and wellbeing
among Aboriginal adults living in Australia that reiterate
the importance of exibility noted in other international
contexts
19
and the use of measures developed specically
for Aboriginal populations where available. We found
that common Western-derived measures used in this
study, including the CD-RISC measure of individual
resilience,
28
and the EQ-5D-5L measure of health-related
quality of life
29
were subject to ceiling and oor effects in
this sample, respectively. This means that on average,
the Aboriginal men and women in this study reported
very high individual resilience and very low health-
related quality of life complaints, with little capacity to
detect benecial changes in either measure over time.
This suggests that these measures may not be suitable
for similar future work that aims to assess health-related
changes among non-clinical samples. Other recent work
with Aboriginal young people suggests that the CD-
RISC is not as strong of a predictor of wellbeing as
other socioemotional measures,
38
afrming the need to
consider alternative measures in future research.
However, we did nd evidence that attending the
camps resulted in a small increase in perceived sources
of relational-community-cultural strength as a source of
resilience, measured using the adapted Aboriginal
Resilience and Recovery Questionnaire. This result
serves as tentative evidence for the unique relational
benets of the camp format which facilitated intergen-
erational sharing and connection between people, as
well as connection to ancestors and Country. While this
result is encouraging, we acknowledge that the broad
concept of resilienceis itself contested and can be
challenging for Aboriginal peoples. Indeed, there was a
robust discussion of the concept of resilienceamong
Aboriginal men and women who participated in the
yarning circle component of the broader Research
Collaborative. This will be the subject of a future paper
from this work.
The repeated measures items we designed to assess
changes in cultural health pre to post camp were also
subject to ceiling effects, with most respondents rating
themselves high on cultural health indicators both pre-
and post-camp. However, given the central importance
of cultural health indicators to this project, and the
exibility that comes with designing our own cultural
health measure, we had the foresight to include differ-
ently worded post-camp items that would be able to
detect meaningful changes because of attending camp
even if pre-post items could not. This methodological
decision proved to be very valuable in revealing
Health-Related Quality of Life Domain Pre-camp problems, nPost-camp problems, nN Z Std Z SE p
None Slight Moderate Severe Extreme/
Unable
None Slight Moderate Severe Extreme/
Unable
Mobility 31 8 3 0 1 33 5 2 0 0 40 36.00 1.73 7.80 0.08
Self-care 42 0 0 0 0 38 0 1 0 0 39 1.00 1.00 0.50 0.32
Usual activities 33 7 2 1 0 35 3 2 0 0 40 3.50 1.90 5.50 0.06
Pain 22 14 7 0 0 18 19 2 1 0 40 49.00 0.24 14.00 0.81
Anxiety/depression 14 22 4 3 0 12 23 4 1 0 40 81.00 0.24 19.00 0.81
Table 4: Tests of differences in pre- and post-camp health-related quality of life measured using the EQ-5D-5L.
Articles
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otherwise undetectable and extremely positive impacts
of camp attendance on cultural health. These positive
results align well with the many stories we heard from
participants about how their connection to culture,
Country, and health more broadly was impacted in a
positive way by spending time at camp. Some of these
stories were shared in mens and womens yarning
circles conducted as a part of the broader Research
Collaborative.
22
Others were shared directly with the
knowledge holders who run the camps or other mem-
bers of the research team. These rich accounts are
critical to rening our approach to quantifying cultural
health in a manner true to those we study and will help
to inform our future work.
The principal limitation of this study is the smaller
than anticipated sample size which prevented us from
being able to explore camp impacts separately for men
and women while accounting for the potential impact of
covariates. Time spent on Country should be healing,
and implementing extensive evaluation procedures
within the camps may have risked undermining the
safety of the camp experiences. Others have noted that
Aboriginal communities may be resistant to evaluation
which can be seen as a colonial mandate undermining
the inherent value of Aboriginal ways of knowing, being
and doing.
39
With that in mind, we restricted survey data
collection to the weeks before the camp for the pre-camp
survey and the end of the nal day of camp for the post-
camp survey. This approach meant that our data
collection did not impede on any of the cultural activities
at camp and prioritised the unobstructed experiences of
participants over data collection needs. However, this
approach also limited our capacity to collect post-camp
surveys from all research volunteers, which resulted in
the smaller than expected sample size in this study. We
speculate that a range of other factors may have further
contributed to reduced capacity to collect post-camp
survey data, including attendees having to deconstruct
the camps and clean the area before departure, and
people being anxious to return home with many trav-
eling hundreds of kilometres to/from camps. Another
limitation of this study is that the increase in familywise
error rate was not controlled across repeated statistical
tests. As noted elsewhere, we consider this research to
be preliminary and we encourage replication among
larger samples. Finally, providing a research incentive
always has the potential to bias responses with nancial
reward, or intimate that the respondents should appease
the researchers by continuing to be involved. However,
we chose to offer a grocery voucher nonetheless, to
compensate participants for the time and labour. We
believe that streamlining our evaluation will be impor-
tant to improving response rates in future research.
Removing measures that may not be able to capture
meaningful change would be a reasonable rst step.
We also had almost twice as many women completing
the surveys than men. This gender imbalance is not
unique to this study, with previous research showing that
men are more difcult to recruit into health interventions
and research.
40
Additionally, there were a greater number
of female research team members on site at camps which
may have contributed to a higher number of post-camp
surveys from those who attended the womenscamping
area.
We also acknowledge the possibility of bias toward
positive evaluations of the camp experience and camp
benets given the sample consisted of people already
motivated to engage in a cultural camp on Country. That
said, this study represents the rst in a very promising
new line of enquiryAboriginal-governed research
seeking to understand the immediate and longer-term
benets of cultural camps for Aboriginal cultural
health in Australia. In the future, we seek to expand this
work among larger, more gender-balanced samples
implementing key learnings regarding the potential for
methodological improvement uncovered by this study.
It would be informative for future work to explore the
generalisability of the results across other Aboriginal
nations around Australia, and to integrate longer term
follow ups to investigate the persistence of benets over
time. Additional work assessing the impact of repeated
camp attendance on indicators of cultural health (to
show dose effect) would also be highly valuable.
Nonetheless, we believe that our results offer compel-
ling preliminary evidence for Aboriginal-led strengths-
based approaches to supporting cultural health on
Country for Aboriginal adults with transparent meth-
odology and ndings that can be adapted for other
contexts.
Conclusion
The Gaawaadhi Gadudha Research Collaborative
seeks to amplify Aboriginal ways of knowing, being
and doing by evaluating existing cultural camps on
Country that utilise traditional cultural knowledge and
healing practices to promote the cultural health of
Aboriginal men and women. Our evaluation process,
which was developed according to the needs and in-
terests of the knowledge holders who guide this work,
revealed promising preliminary evidence for the
impact of attending camps on cultural health, while
also uncovering opportunities for methodological
improvement in future research. The data presented
here, in concert with other papers in this special
collection,
2022
highlights the Research Collaborative as
a proof-of-concept model for supporting Aboriginal
cultural health. Ultimately, we hope this work con-
tributes to accelerated and deepening interest in
strengths-based models promoting cultural health
both locally and internationally.
Contributors
BB: Conceptualisation; Methodology; Formal analysis; Investigation;
WritingOriginal draft; Writingreview and editing; Project admin-
istration; Funding acquisition.
Articles
10 www.thelancet.com Vol 52 November, 2024
AY: Conceptualisation; Methodology; Investigation; Writingre-
view and editing; Supervision; Project administration; Funding
acquisition.
AZ: Methodology; Investigation; Writingreview and editing;
Funding acquisition.
JK: Methodology; WritingOriginal draft; Writingreview and
editing; Funding acquisition.
MOL: Conceptualisation; Methodology; Supervision; Writingre-
view and editing; Funding acquisition.
NS: Methodology; Investigation; Project administration; Writing
review and editing.
SMT: Methodology; WritingOriginal draft; Writingreview and
editing; Funding acquisition.
BJB: Methodology; Writingreviewing and editing; Funding
acquisition.
TF: Conceptualisation; Methodology; Supervision; Writingreview
and editing; Funding acquisition.
WF: Conceptualisation; Methodology; Supervision; Writingreview
and editing; Funding acquisition.
BB and AY had access to the raw data. BB had nal responsibility for
the decision to submit for publication.
Data sharing statement
The study protocol is available elsewhere.
8
The study materials are made
available in the Supplementary le. Individual participant data is not
made available to external parties.
Declaration of interests
The authors declare no conicts of interest.
Acknowledgements
We would like to acknowledge all study participants who contributed
their time and data to this research. We acknowledge Wendy Jopson
who contributed to this project. BB is supported by Australian Research
Council Laureate Fellowship FL190100011.
Appendix A. Supplementary data
Supplementary data related to this article can be found at https://doi.
org/10.1016/j.lanwpc.2024.101200.
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... 8 Included in this is the concept of culture-ashealth, 8 and cultural health 2,9 which recognise that health is a cultural phenomenon and should be at the centre of all health and wellbeing initiatives aimed to benefit Aboriginal peoples. In the other articles in this collection, Fields et al., 10 define the three necessary elements of cultural health as Country, people, and culture and their interdependent and intertwining relationship with one another; while Brady et al., 11 measures cultural health through inquiry into individual connection to culture, and individual/collective access to cultural knowledges, and resources. In addition the aspects of spirituality, communality, and cultural practices and identity, are discussed in a review of the literature documenting aspects of cultural health included in this series. ...
... The camps provided a unique platform to study cultural health in place, including the ways in which it can be engaged with or strengthened during camp participation. Indicators of cultural health (see also Brady et al., Biles et al.) 11,12 include pride in cultural identity; cultural knowledge (e.g. sites, foods, medicines, stories); knowledge and practice of Aboriginal language; attachment to mob (a group of Aboriginal people associated with a particular place or Country) or nation; connection to Country; connection to ancestors; and access to cultural resources (e.g. ...
... The results of our study suggest that camps provide therapeutic experiences and social, emotional, and spiritual health benefits for Aboriginal peoples. An associated paper in this collection 11 provides further quantitative evidence of this impact, triangulating the lived experiences of participants reported here. There are few examples of camps as a Country or 'land-based' platform for Indigenous health and wellbeing initiatives. ...
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Background Culture and its practice is a recognised, but not well understood factor, in Aboriginal health and wellbeing. Our study aimed to explore how health and wellbeing are phenomenologically connected to cultural practices, foods, medicines, languages, and Country, through the platform of ‘on-Country’ camps facilitated by Aboriginal cultural knowledge holders in NSW, Australia. Methods Our study is based on a collaboration between knowledge holders from freshwater and saltwater cultures, and Aboriginal and non-Aboriginal researchers. Three existing cultural camps on Yuwaalaraay, Gamilaraay, and Yuin-Djirringanj Country were observed as part of the study. Within the camps, eight yarning circles were conducted with 76 participants. Data were analysed inductively using literal code descriptors which were cross tabulated to identify emergent patterns relevant to the study aims. Findings Three key areas emerged from our analysis: 1) what constitutes cultural health; 2) the way in which cultural camps provide a mechanism for improved cultural health and; 3) the key elements needed to deliver a cultural camp that provides therapeutic benefits. Camps had a positive effect on participants’ social, emotional, and spiritual health and wellbeing, often described through experiences of healing or stress relief, connection with Country and each other, and engaging in cultural practices. Interpretation ‘On-Country’ camps that are facilitated by place-based knowledge holders, provide a unique and promising platform that supports Aboriginal health and wellbeing through therapeutic, sensory experiences that strengthen cultural health; including cultural identity, knowledge gain and sharing, connection to Country, mob, and ancestors, and engagement in cultural practices. Access to Country and land to conduct camps remains a barrier to their delivery. Funding This study was funded by the Australian Government’s Medical Research Future Fund (MRF2009522).
Article
This article is written from the perspectives of a Yuwaalaraay/Gamilaraay cultural knowledge holder and a Yuin Djirringanj cultural knowledge holder from New South Wales, Australia. It explores the concept of cultural health, and the need to shift towards centring culture in every aspect of Aboriginal health and wellbeing. The three elements of cultural health are discussed as Country which includes lands, waters, skies, and all entities within; people, and their freedom, and ability to express and maintain continuing connections to culture and Country; and culture which encompasses identity, language, and knowledges, and is maintained and strengthened through active connection to Country, and cultural practices. Cultural health is out of balance due to invasion and ongoing colonisation which translates to the differences in health and social outcomes we see represented in ‘the gap’, fails to acknowledge or centre our cultural health, and remains a challenge in making significant progress in health and social outcomes. It is reflected in many of the unmet or receding targets. To improve Aboriginal health and wellbeing, data exploring the different aspects of ‘the gap’ in cultural health from a strength-based approach, as opposed to the gap in deficit and disease is required.
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Indigenous cultural health is an emerging field of research and reflects the unique connections Indigenous peoples have with their Country, culture, and knowledge systems. This narrative review explores the concept of cultural health focusing on the interplay between culture, health, and wellbeing within settler colonial contexts. The review is mostly focused on Australian research, despite its international scope. A narrative review methodology was employed, search terms were compiled, and a title and abstract search was executed across two databases (Scopus, PubMed), confined to English language papers, with a focus on Australia. Three key themes were identified: Country; culture, and Indigenous knowledges. Country is vital to health. Culture practices offer frameworks for healing nurturing the relationship between people, Country and culture. Privileging Indigenous knowledges is a means to achieving health and wellbeing. Indigenous cultural health encompasses the interconnectedness of Country, people and culture, demanding a holistic approach that integrates Indigenous knowledges and practices. In Australia, these core components of cultural health must be situated in a contemporary context of ongoing colonisation. This narrative review underscores the importance of culturally centred approaches in addressing health inequities and enhancing the wellbeing of Indigenous peoples. Funding This study was funded by the Australian Government’s Medical Research Future Fund (MRF2009522 & MRF2025330).
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The world is currently grappling with several public health issues (like the increase in urbanization, chronic diseases and social isolation). Increased connection with nature has been identified as a possible solution to many of these concerns. This perspective paper draws on recent empirical evidence around the health and wellbeing benefits of nature. To highlight these benefits I will draw on insights from my own research focused on Indigenous people’s connection to land (known as Country in Australia) and gardening as a mechanism for engaging people in nature. This will be applied to support the notion that nature is critical infrastructure that has significant potential to improve public health outcomes. In doing this it must be acknowledged that these are only a few aspects of the relationship between nature and health based on my own expertise and paradigms developed from my research. I will conclude this perspective essay by providing five overarching recommendations to mainstream the evidence substantiating the health and wellbeing benefits of nature into policy and practice.
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Background Culture and its practice is a recognised, but not well understood factor, in Aboriginal health and wellbeing. Our study aimed to explore how health and wellbeing are phenomenologically connected to cultural practices, foods, medicines, languages, and Country, through the platform of ‘on-Country’ camps facilitated by Aboriginal cultural knowledge holders in NSW, Australia. Methods Our study is based on a collaboration between knowledge holders from freshwater and saltwater cultures, and Aboriginal and non-Aboriginal researchers. Three existing cultural camps on Yuwaalaraay, Gamilaraay, and Yuin-Djirringanj Country were observed as part of the study. Within the camps, eight yarning circles were conducted with 76 participants. Data were analysed inductively using literal code descriptors which were cross tabulated to identify emergent patterns relevant to the study aims. Findings Three key areas emerged from our analysis: 1) what constitutes cultural health; 2) the way in which cultural camps provide a mechanism for improved cultural health and; 3) the key elements needed to deliver a cultural camp that provides therapeutic benefits. Camps had a positive effect on participants’ social, emotional, and spiritual health and wellbeing, often described through experiences of healing or stress relief, connection with Country and each other, and engaging in cultural practices. Interpretation ‘On-Country’ camps that are facilitated by place-based knowledge holders, provide a unique and promising platform that supports Aboriginal health and wellbeing through therapeutic, sensory experiences that strengthen cultural health; including cultural identity, knowledge gain and sharing, connection to Country, mob, and ancestors, and engagement in cultural practices. Access to Country and land to conduct camps remains a barrier to their delivery. Funding This study was funded by the Australian Government’s Medical Research Future Fund (MRF2009522).
Article
Full-text available
Indigenous cultural health is an emerging field of research and reflects the unique connections Indigenous peoples have with their Country, culture, and knowledge systems. This narrative review explores the concept of cultural health focusing on the interplay between culture, health, and wellbeing within settler colonial contexts. The review is mostly focused on Australian research, despite its international scope. A narrative review methodology was employed, search terms were compiled, and a title and abstract search was executed across two databases (Scopus, PubMed), confined to English language papers, with a focus on Australia. Three key themes were identified: Country; culture, and Indigenous knowledges. Country is vital to health. Culture practices offer frameworks for healing nurturing the relationship between people, Country and culture. Privileging Indigenous knowledges is a means to achieving health and wellbeing. Indigenous cultural health encompasses the interconnectedness of Country, people and culture, demanding a holistic approach that integrates Indigenous knowledges and practices. In Australia, these core components of cultural health must be situated in a contemporary context of ongoing colonisation. This narrative review underscores the importance of culturally centred approaches in addressing health inequities and enhancing the wellbeing of Indigenous peoples. Funding This study was funded by the Australian Government’s Medical Research Future Fund (MRF2009522 & MRF2025330).
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Introduction The health and well-being of Aboriginal Australians is inextricably linked to culture and Country. Our study challenges deficit approaches to health inequities by seeking to examine how cultural connection, practice and resilience among Aboriginal peoples through participation in ‘cultural camps’ held on sites of cultural significance promotes health and well-being. Methods and analysis The study will be undertaken in close collaboration and under the governance of traditional cultural knowledge holders from Yuwaalaraay, Gamilaraay and Yuin nation groups in New South Wales, Australia. Three cultural camps will be facilitated, where participants (n=105) will engage in activities that foster a connection to culture and cultural landscapes. A survey assessing connection to culture, access to cultural resources, resilience, self-rated health and quality of life will be administered to participants pre-camp and post-camp participation, and to a comparative group of Aboriginal adults who do not attend the camp (n=105). Twenty participants at each camp (n=60) will be invited to participate in a yarning circle to explore cultural health, well-being and resilience. Quantitative analysis will use independent samples’ t-tests or χ² analyses to compare camp and non-camp groups, and linear regression models to determine the impact of camp attendance. Qualitative analysis will apply inductive coding to data, which will be used to identify connections between coded concepts across the whole data set, and explore phenomenological aspects. Results will be used to collaboratively develop a ‘Model of Cultural Health’ that will be refined through a Delphi process with experts, stakeholders and policymakers. Ethics and dissemination The study has ethics approval from the Aboriginal Health and Medical Research Council (#1851/21). Findings will be disseminated through a combination of peer-reviewed articles, media communication, policy briefs, presentations and summary documents to stakeholders.
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Background Indigenous experiences and perspectives of resilience, healing and recovery from trauma is gaining increasing attention, with a growing qualitative literature that spans multiple indigenous cultural groups. However, few quantitative measures are available. In this article, development of a preliminary version of the Aboriginal Resilience and Recovery Questionnaire is described. Aim The first aim of this study was to describe findings from two focus groups that provided theoretical knowledge and development of items for a draft version of an Aboriginal Resilience Recovery Questionnaire. The second aim of the study was to conduct a preliminary psychometric analysis of the properties of the measure. Design Multi-method research design grounded in indigenous research methodologies. Measures Aboriginal Resilience and Recovery Questionnaire, Australian Aboriginal Version of the Harvard Trauma Questionnaire Trauma symptom subscale, Growth and Empowerment Measure. Results (1) Two focus groups with six counselling staff from an Aboriginal health service were run that explored Victorian Aboriginal understandings of resilience, healing, and recovery from trauma. Sixty different protective factors viewed as potentially important to resilience, healing and recovery from trauma were identified by participants. (2) Following a review of the resilience literature, 75 items were reviewed and revised, with additional items developed by the focus group. (3) The final outcome was 60 items selected for a preliminary version of the Aboriginal Resilience Recovery Questionnaire, 50 of which made up 19 different subscales in addition to 10 single items. (4) Structured interviews were conducted with 81 help seeking Aboriginal clients recruited from the same health service. Preliminary psychometric assessment of the Aboriginal Resilience Recovery Questionnaire was undertaken using Principal Components Analysis. Two component subscales were extracted with adequate internal consistency and good convergent and discriminant validity. For both subscales there were moderate to strong positive associations with empowerment, and moderate to strong negative associations with trauma symptom severity. Conclusion The preliminary results are promising for a strength-based resilience measure developed from the knowledge of Aboriginal practitioners and staff of a counselling service. Further research to address some psychometric limitations in the measure is required. A larger sample size will allow for a common factor analysis to be conducted. The Aboriginal Resilience Recovery Questionnaire has potential to assist Aboriginal Community Controlled Health Organisations and other organisations to evaluate whether services and programs can effectively support community members to strengthen individual, relational, community and cultural resilience resources.
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Emerging evidence from the western literature suggests an increasing focus on applying nature-based interventions for mental health improvements. However, in Indigenous communities, caring for country has always been central to the Indigenous way of life. Knowing that nature-based interventions effectively improve mental health outcomes, this review collated evidence on the application of caring for country in improving social and emotional well-being (SEWB) of Indigenous peoples in Australia and New Zealand. Three studies from Australia and one from New Zealand, explored the role of country or whenua (land) in the lives of Indigenous people. Participation in caring-for country activities was associated with lower levels of psychological distress and strengthened guardianship relationship with country, which positively affected SEWB. This systematic review offers preliminary evidence on the role of caring for country activities in improving the SEWB of Indigenous peoples and highlights the need for strengths-based approaches to improve the SEWB of Indigenous peoples. Funding None.
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Purpose We aimed to test the reliability and validity of two brief measures of resilience adopted for the evaluation of a preventative social-emotional curriculum implemented for Aboriginal middle school students from socially disadvantaged remote communities in Australia’s Northern Territory. The questionnaires chosen were intended to measure psychological resilience and socio-cultural resilience as complementary dimensions of the capacity to cope in circumstances of significant life stress and risk of self-harm. Methods Confirmatory factor analysis (CFA) was conducted to assess construct validity of the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), a measure of psychological resilience, and the 12-item Child and Youth Resilience Measure (CYRM-12), a measure of socio-cultural resilience, with a sample of 520 students. Associations between resilience and psychological distress and emotional and behavioural difficulty were analysed in relation to life stressors to assess criterion validity of the scales. Results CFA provided support for the validity of the respective constructs. There was good fit for both scales. However, assessment of criterion validity of the scales suggested that the adapted measure of socio-cultural resilience (CYRM-12NT) showed higher reliability and a clearer indication of predictive validity than the measure of psychological resilience (CD-RISC-10). Conclusions The CYRM-12NT appears to be a more useful measure of resilience among Aboriginal youth exposed to significant life stress and disadvantage. However, both measures may require further development to enhance their validity and utility among potentially at-risk adolescents in socially, culturally and linguistically diverse remote Aboriginal communities.
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The myriad and cumulative impacts of climate change on land, communities, and health are increasingly evident worldwide. Throughout 2019 and 2020, Fort William First Nation and researchers at Lakehead University conducted a project to document and understand connections among climate change, land, and health from the perspective of Elders, knowledge keepers, and community members with close ties to the land. Fort William First Nation is an Anishinaabe community located on the shores of Lake Superior/Kitchigami in Northern Ontario and within Robinson-Superior Treaty territory. This paper describes the analysis of interviews with 22 community members. Two-Eyed Seeing, an approach that centers the working together of Indigenous and non-Indigenous knowledges and peoples and demands respectful relationship building, guided our project and analysis. Our analysis identified five themes: 1) observations and experiences of changes on the land, 2) lack of care and respect for Mother Earth as the root cause of climate change, 3) healthy land, healthy people, 4) youth and future generations, and 5) (re-)connecting with land and culture. “All our Relations” is a thread woven across these themes emphasizing that climate change is understood and experienced through relationships and relationality. As concluding thoughts and reflections, we share three specific offerings of particular relevance to those engaging in climate change and health research and action with Indigenous peoples and communities. First, this research has highlighted the importance of explicitly centering land when exploring the links between climate change and health. Second, we reflect on the value of both the Two-Eyed Seeing approach and the Medicine Wheel in guiding climate change and health research. Third, we argue for an explicit focus on relationships and relationality in efforts aimed at understanding and addressing climate change.
Article
This article is written from the perspectives of a Yuwaalaraay/Gamilaraay cultural knowledge holder and a Yuin Djirringanj cultural knowledge holder from New South Wales, Australia. It explores the concept of cultural health, and the need to shift towards centring culture in every aspect of Aboriginal health and wellbeing. The three elements of cultural health are discussed as Country which includes lands, waters, skies, and all entities within; people, and their freedom, and ability to express and maintain continuing connections to culture and Country; and culture which encompasses identity, language, and knowledges, and is maintained and strengthened through active connection to Country, and cultural practices. Cultural health is out of balance due to invasion and ongoing colonisation which translates to the differences in health and social outcomes we see represented in ‘the gap’, fails to acknowledge or centre our cultural health, and remains a challenge in making significant progress in health and social outcomes. It is reflected in many of the unmet or receding targets. To improve Aboriginal health and wellbeing, data exploring the different aspects of ‘the gap’ in cultural health from a strength-based approach, as opposed to the gap in deficit and disease is required.
Article
Objectives and importance of the study: Most older Aboriginal peoples live in urban locations. Many of these people were displaced by the policies and practices that produced the Stolen Generations. As a result, access to ‘Country’ and cultural landscapes that are minimally impacted by urbanisation can be limited for older Aboriginal peoples, restricting the health and wellbeing benefits these environments promote. Study type: Qualitative study. Methods: Our study worked collaboratively with Aboriginal traditional cultural knowledge holders to observe and analyse how participation in a ‘cultural camp’ on a Yuwaalaraay sacred site in New South Wales (NSW), Australia, impacted wellbeing and connection to place among older Aboriginal people who were survivors or descendants of the Stolen Generations. Results: Eight participants (three women; five men) attended the cultural camp and took part in the yarning circle. Thematic analysis of a yarning circle uncovered memories of traumatic experiences of institutionalisation, including abuse and loss of Country, community, and culture. Experiences of the cultural camp generated a sense of reconnection, cultural pride, wellbeing and place attachment. The sensory experience of Country emphasised a sense of belonging and healing. Conclusions: Our findings reflect the importance of sensory-led experiences on Country for older urban Aboriginal peoples and reinforce previous evidence on the ‘therapeutic’ aspects of culture and natural landscapes minimally impacted by colonisation. Policies and resources supporting grassroots initiatives such as Aboriginal cultural camps are needed to ensure accessibility for older Aboriginal peoples living in urban places.
Article
There are an estimated 370 million Indigenous peoples living in more than 70 countries. Indigenous populations are defined as the First Peoples occupying countries or regions at times of colonization, with distinct cultural, religious, and social practices that distinguish them from other populations. Indigenous peoples across the globe have deep, intimate, holistic, localized, and reciprocal relationships and connections to their “Country” (as it is known in Australia), which includes elements of the land, sea, waterways, sky, stars, and living and nonliving entities. This relationship is largely unacknowledged through Western biomedical models of health, which tend to focus on individual risk behaviors and disease outcomes, thereby situating Indigenous health inequities in terms of deficiency and ignoring the ongoing impacts and trauma of colonization. Indigenous concepts of health are holistic, encompassing emotional, physical, cultural, and spiritual health. Country is central to health and is steeped in the harmonized interrelationships that constitute cultural well-being. Models for measuring and understanding health outcomes for Indigenous peoples need to respectfully incorporate the full range of determinants that are relevant to their health that understand the importance of connection to Country.