Health risk factors in Aboriginal community controlled health services: an exploration of prevalence, clustering, screening options and intervention preferences

Aboriginal and Torres Strait Islander Australians have a substantially lower life expectancy and greater burden of chronic disease than their non-Indigenous Australian counterparts. The current health status of Indigenous Australians can be linked to a history of colonization and dispossession, as well as to past and ongoing racism and discrimination. While acknowledging the need to address such broader social determinants of health, there is also significant potential to improve the health of Aboriginal and Torres Strait Islander Australians through reducing the disproportionate prevalence of key health risk behaviours among this population, such as smoking, poor diet, excess alcohol and physical inactivity. Primary care is an important setting for the delivery of preventive health care, and Aboriginal Community Controlled Health Services (ACCHSs) are well placed to provide primary care for Aboriginal communities. A range of preventive care interventions have shown success in modifying health risk behaviours in non-Indigenous healthcare settings. However, such strategies are not well tested in Aboriginal health. Therefore this thesis aimed to explore the acceptability of strategies including point-of-care screening, and the provision of patient feedback, in the ACCHS setting. The need for primary care to address ‘lifestyles’ or patterns of interrelated health risks is also being increasingly recognized. In order to inform the provision of more holistic preventive care, this thesis also explored the clustering patterns of key health risk behaviours among ACCHS clients. Patient preferences for addressing their health risks, including whether health risks should be addressed individually, sequentially or simultaneously, and the types of support that would be most helpful, were examined. Implications of the results of these studies for the delivery of appropriate and effective primary care for Aboriginal and Torres Strait Islander Australians are discussed. Based on these findings and drawing on the existing literature, a multi-component, community-based intervention aimed at reducing multiple health risk behaviours is also proposed.