September 14, 2021
This article is republished from Croakey Health Media with permission. Editor: Melissa Sweet
Authors: Bronwyn Fredericks, James Ward, Sue McAvoy, Troy Combo, Shea Spierings, Abraham Bradfield and Agnes Toth-Peter
An innovative new study is using systems thinking to map responses to COVID-19 among Indigenous communities in Brisbane, report researchers from the University of Queensland.
Initial findings include that vaccine uptake is partly determined by the degree to which Indigenous peoples trust government policy. To improve vaccine rates amongst Aboriginal and Torres Strait Islander peoples, trust must also be ensured.
A study being conducted by the University of Queensland, led by Professor Bronwyn Fredericks, and Professor James Ward, seeks to unpack the complexities of Indigenous health and social systems to better understand the effectiveness of responses to COVID-19 in Brisbane.
Guided in systems thinking by Dr Sue McAvoy, a Participatory System Dynamics approach is tapping into the experiences and collective expertise of health organisations and key stakeholders who are working with urban Indigenous communities. The aim is to gain a holistic understanding of the risks and protective factors in urban Indigenous settings during for COVID-19.
It is well documented that Indigenous populations worldwide are amongst those who are at greatest risk of succumbing to COVID-19. Where Indigenous communities internationally have suffered disproportionate infections and deaths in comparison to non-Indigenous populations, until very recently Aboriginal and Torres Strait Islander peoples are had not recorded a single fatality.
Indigenous communities in Australia have taken great initiative, demonstrating self-determination when responding to the threat of COVID-19. While the vaccine rollout has been met with reservation and hesitancy within many Indigenous communities, some communities have achieved an uptake above the national average.
Although the pandemic and subsequent lockdowns have posed numerous health risks for Indigenous peoples, in the most part, it has merely exacerbated pre-existing issues relating to underlying health conditions, food insecurity, housing, and other social determinants of disparate health outcomes.
The pandemic has exposed many structural and systemic failing but has also provided opportunities to implement long-term and meaningful change. We have heard firsthand testimony from Indigenous peoples who have expressed their staunch opposition to the prospect of returning to a pre-pandemic “normal”.
This study seeks to better understand the structural reforms needed to construct an effective health system, particularly during times of pandemics. It draws on the collective knowledge and experience of Indigenous and non-indigenous service-providers and healthcare professionals while recognising that Aboriginal and Torres Strait Islander peoples are the experts of their own needs and that sustainable change must be community orientated and driven.
This innovative study brings service-providers, healthcare representatives, and other stakeholders together with the aim of collectively unpacking the complexities of responding to significant health crises.
While other studies have investigated the impact of COVID-19 in urban Aboriginal and Torres Strait Islander communities, for example the Centre for Social Research in Health’s qualitative research in NSW, none have approached the subject through “Systems Thinking”.
Twenty key stakeholders from the Brisbane metropole have shared their expertise as researchers, executive staff, and service providers within community-controlled health organisations, hospital and health services, and NGOs. This Indigenous-led research is funded by the Paul Ramsay Foundation as part of the Australian Partnership for Preparedness Research on Infectious Diseases Emergencies (APPRISE) program.
The research consists of three workshops, the first of which was conducted in June 2021. The first workshop focused on identifying and conceptualising the challenges faced when navigating and working within the health system during a pandemic.
The second workshop, held recently as per the tweet below, sought to unpack the causal links and interdependencies of the “cogs” of “levers” that drive the system.
The final workshop will be held in October and focus on policy insights and the actions needed to generate better outcomes for Aboriginal and Torres Strait Islander communities. Each workshop is built upon “systems thinking” and informed by a “Participatory Systems Dynamics” methodology.
The benefits of a “systems approach” lies in its ability to identify the implications of decision-making and the consequences of policy interventions during health crises. This has been documented by experts in systems theory and public policy.
Systems theory is endorsed by the OECD and is recognised by the World Health Organization as a framework that has the potential to transform existing systems to achieve desirable outcomes, particularly during pandemics.
Central to the methodology is developing visual maps, known as “Causal Loop Diagrams”, that help structure and conceptualise issues in a whole of system approach. The first workshop provided a foundation upon which a causal loop diagram could be constructed. In this workshop, the stakeholders engaged in numerous activities that sought to identify and understand:
- The goals and objectives stakeholders are trying to achieve through their COVID-19 interventions.
- The approaches, policies, and responses that have been most effective when responding to COVID-19.
- The most important elements or variables within a system, and those which should be prioritised during health crises in urban Aboriginal and Torres Strait Islander communities.
Participants were asked to deliberate and identify the top eleven elements, or variables, they saw as influencing the efficacy of COVID-19 responses. Having identified them, participants were then asked to consider how the elements/variables are connected.
As an example, vaccine uptake was identified as being partly determined by the degree to which Indigenous peoples trusted government policy. To improve vaccine rates amongst Aboriginal and Torres Strait Islander peoples, trust must also be ensured.
The study thus far has proven effective in encouraging “systems thinking” amongst stakeholders by identifying the subsystems that both influence decision-making and shape Indigenous people’s experiences and interactions with and within the healthcare system.
Stakeholders collectively identified policy, family, culturally appropriate communications, workforce capacity, financial issues, vaccine uptake, and cultural events or “business” (amongst others), as playing a part in determining the outcomes of the health system’s response to COVID-19 for Indigenous peoples in urban Brisbane.
Understandings of these elements are essential to developing holistic and culturally appropriate responses to health crises that are effective, minimise risk, and ultimately empower Aboriginal and Torres Strait Islander communities.
Simply identifying these key elements, however, is not enough to change dominant thought patterns and current decisions.
For real systemic change to occur, greater understanding of the connections and feedbacks between and amongst each element is needed. We look forward to our further workshop, which will explore these connections and feedback loops in further detail in hope of shifting the ways in which we think and informing the way we respond to health crises.
This project is funded through the National Health and Medical Research Council Centre of Research Excellence (NHMRC CRE), the Australian Partnership for Preparedness Research on Infectious Disease Emergencies (APPRISE, AppID 1116530) through a donation from the Paul Ramsay Foundation.
See the references cited in this article here.