Health Advancement and Promotion

This paper critically examines four qualitative research articles on Indigenous health promotion in Australia and their methodological rigour in closing the health gaps.

Running head: HEALTH ADVANCEMENT AND PROMOTION 1
Health Advancement and Promotion
Name
Institutional Affiliation

HEALTH ADVANCEMENT AND PROMOTION 2
HEALTH ADVANCEMENT AND PROMOTION
Introduction
Indigenous health promotion in Australia is gaining momentum as the efforts to solve
gaps in Indigenous health amongst the Aboriginal escalate. These gaps have been described
nationally and internationally. The qualitative study has focused on probing the causes of these
gaps to help close the health gaps by honouring the self-determination of Indigenous population,
advocating for equal opportunities for Aboriginals to be health and endowing the public health
workforce to offer high-quality and culturally-safe care. This paper critically examines four
qualitative research articles on the topic in terms of their methodological rigour or
trustworthiness, and the weaknesses and strengths to help understand whether researchers are on
the right track to help close these gaps.
Povey, J., Mills, P. P. J. R., Dingwall, K. M., Lowell, A., Singer, J., Rotumah, D., ... &
Nagel, T. (2016). Acceptability of mental health apps for Aboriginal and Torres
Strait Islander Australians: a qualitative study. Journal of medical Internet
research, 18(3), e65. https://www.jmir.org/2016/3/e65/
The main of this study was spelt out and hence made it possible to understand what is
under probe at a glance. The study aimed at exploring Aboriginal and Torres Strait Islanders
community members' experiences of utilizing culturally responsive e-mental health apps and
acknowledge the variables influencing such approaches acceptability.
The authors used a suitable method to carry out the study. Because the issues under the
survey were non-numerical, but more of behaviour and reasoning, it was proper not to use
quantitative research method but a qualitative one. This qualitative method was effectively
aligned with a phenomenological approach which made it easier for the authors to explore the

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acceptability of 2 culturally-responsive e-mental health applications via series of three 3-hour
focus groups with nine members of Aboriginal and Torres Strait Islander community (Povey et
al. 2016).
Moreover, being a qualitative study, the authors correctly chose the thematic analysis
with co-researcher alongside member properly checking being used to verify the results. The
design used in this study was useful because it drew from an extensive survey performed in
northern NSW. The authors effectively discussed the sampling, design as well as recruitment
strategy with the Aboriginal researcher as well as expert reference groups which efficiently
guided additional e-mental health projects in NT hence making sure there was local relevance.
The authors also received the ethics approval from the Human Research and Ethics Committee
for the NT department of health alongside Menzies school of health research, which also
included Aboriginal and Torres Strait Islander Committee. Receiving an ethical approval is a
critical part of doing a study which ensures the trustworthiness of the study.
The recruitment used purposive sampling, which aimed at recruiting six to eight
Aboriginal and Torres Strait Islander community members. Purposive sampling is a useful
technique for qualitative research, and hence, it fits this current study. It was also practical since
the local service providers were requested to nominate participants anchored on the correct
exclusion and inclusion criteria, which ensured quality recruitment. It was also sufficient to
recruit people above eighteen years and those who could attend al the three 3-hour cohorts. The
authors also provided that they only hired people who were willing and able to talk in these
groups' contexts in English as this would ensure there is no forced participation and hence proper
collection of data.

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Moreover, it was adequate to include only those who had not attended a severe and florid
kevel of mental illness because this would be a confounding factor hence not giving the right
results. It was also useful in this case because the participants had to be identified as Aboriginal
or Torres Strait Islander as the study was aimed at only dealing with the Indigenous population.
The authors correctly obtained written informed consent through the expression of the interest
form hence ensuring that only people who had agreed to participate willingly were recruited. The
researcher also ensured that there was no bias by having the research team selecting participants
for optimal variations which aimed at even number of female or males and a broad array of ages.
The data collection was valid because the focus groups were enhanced by a female non-
Indigenous researcher as well as a male Aboriginal researcher who had experience working with
these Indigenous population with mental illness. Moreover, the researchers ensured
confidentiality by having every focus group beginning with a statement that requested
confidentiality from the members of the group. The authors managed risk effectively and
demonstrated correctly how each app is used.
The main weakness of the study is the small sample size of only nine people hence lacks
generalizability to the entire population. The main strength is that the authors ensured
confidentiality and obtained written informed consent. All these are critical features of a
trustworthy status. Another strength is that all participants received reimbursement for their time,
transport alongside additional expenses by the AUS eighty dollars shopping voucher per three-
hour session. The storage was also reliable since the sessions were voice recorded and back-up
field notes were taken, which including observations and reflections of the researcher.
Puszka, S., Dingwall, K. M., Sweet, M., & Nagel, T. (2016). E-mental health innovations for
Aboriginal and Torres Strait Islander Australians: a qualitative study of

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implementation needs in health services. JMIR mental health, 3(3), e43.
https://mental.jmir.org/2016/3/e43/?
utm_source=TrendMD&utm_medium=cpc&utm_campaign=JMIR_TrendMD_0
The main objective of this study was to fathom the perspective of the stakeholders on the
requirements for the implementation of the approaches of e-mental health in regional as well as
remote health services for the Indigenous Australians.
The method used in this study was effective and highly trustworthy. The authors used
qualitative research, which was valid because the issues under the survey were non-numerical or
statistical but involved behaviour and reasoning; hence, it was not suitable to use quantitative
research. Moreover, the instruments used in the study was qualitative interviews which were an
effective method of collecting first-hand data to inform the understanding of the perceptions of
the stakeholders on the e-mental health implementation requirements and how they could help
close the gaps in the Indigenous health (Puszka, Dingwall, Sweet & Nagel, 2016). The interview
of the 32 managers, chief executives, directors and senior practitioners of mental health, alcohol
and other drug and chronic services as useful as these are the main stakeholders who would drive
the closure of these gaps. However, it must be noted that this sample size was too small for
generalization to the entire population. There would be a need for a larger sample to confirm the
findings in this study.
Data collection through semi-structured qualitative interviews was useful in the
exploration of the present and potential utilization of e-mental health approaches with the
Indigenous people. The methodology was also rigorous because the authors got the approval
from the relevant ethic commits, which even included the Aboriginal sub-committee. The

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recruitment of the participants into the study was thorough right from the development of the
semi-structured interview guide based on the critical review of the literature. This guide was able
to cover both pieces of knowledge of as well as attitude towards e-mental health. The questions
asked in the interview were not biased or leading questions but were open-ended and hence
enabled the interviews to give a justification of their responses, unlike just "no or yes'" questions.
The approach to the participants was practical as this was done based on both personal
and professional network alongside knowledge of sector before the participation in the e-mental
health training. Moreover, the decision to use snowball alongside maximum variance sampling
techniques was effective in collecting the desired data from a wide range of service types and
organization hence ensuring a principle of triangulation as participants were even included from
the outside of the internal networks. It was also sufficient to use both individual and group
interview since it allowed the participant to select their preferred format and setting of the
interview based on their preferences and convenience. The interviews were also properly
recorded, transcribed verbatim as well as checked against audio recordings which ensured
correct data from first hand without any distortion.
The analysis was useful and comprehensive based on the grounded theory methodology
that efficient helped the researchers to construct a localized knowledge regarding the utilization
of the e-mental health in health services for the Indigenous Australians from the gathered data. It
was also a good practice for the researchers to oscillate the analysis between inductive and
deductive approaches. Further breaking down the data into discrete portions and subsequently
comparing and contrasting with the rest of the data, and placed back together in the new category
was proper because it made connections between the categories involving consequences, context
and conditions possible following the Straus and Corbin methods.

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One of the most significant limitations of this study was a small sample size of 32
participants; hence, results cannot be generalized to the entire population. Another weakness is
that the informed consent of the interviewees was not sought or the researchers just chose to
leave this vital part highlighted in the methods of recruitment. One of the greatest strength of the
article is they use semi-structured interviews which could be taken in groups and as an individual
based on preference and convenience of the interviewee. Another strength of the study is that all
authors effectively immersed themselves in the data via reading as well as re-reading transcripts
and each of them developing codes and subsequently arriving at one set of axial codes and sub-
codes within each via the agreements of the groups based on the model of diffusion of
innovations. Storage of data in the NVIVO software was also effective in supporting both
transcript storage and coding.
Hinton, R., Kavanagh, D. J., Barclay, L., Chenhall, R., & Nagel, T. (2015). Developing a
best practice pathway to support improvements in Indigenous Australians’ mental
health and well-being: a qualitative study. BMJ Open, 5(8), e007938.
https://bmjopen.bmj.com/content/5/8/e007938?
itm_content=consumer&itm_medium=cpc&itm_source=trendmd&itm_term=0-
A&itm_campaign=bmjo
The main objective of this study was to establish the need to adapt pathways in caring
and to promote access to the mental health services for the Indigenous population in Australia.
Thus, this study effectively explored Indigenous society alongside the service view of well-being
ways for promoting access to care for this population at risk of depressive disorder.
The study used a suitable research design that employed a participatory action research
framework, thereby adequately informing the development of the agreed-early intervention

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pathway. The authors effectively used snowball alongside purposive sampling techniques, which
are all excellent techniques for a qualitative study. These led to a sample size of twenty-seven
service providers alongside community members cautious of local contexts and the multiple
needs of the people at risk of depression. The authors used a useful research instrument,
interview to gather first-hand information or primary data, which is more effective than
secondary data. This makes this method a vigorous one and as it helps adapt a pathway to care
based on the feedback of the participants (Hinton, Kavanagh, Barclay, Chenhall & Nagel, 2015).
The strength of the study is that it increased the understanding of stressors and strengths
in 2 remote Indigenous communities, and in reaction. This helped identify the desired pathways
and resources for caring for the community. It further helped develop a community-specific best-
practice pathway map. Another strength is that it informed the development of an integrated,
cooperative and coordinated approach to mental healthcare, which is flexible, smooth, culturally
smooth and easily navigable. It significantly contributes to the desired shift in the current culture
in mental healthcare, to the prevention as well as early intervention from the acute treatment
preference. One of the weakness lies in the small-focused which prohibits generalization, even
though two areas stood included and the principles are never probably significantly vary.
Waterworth, P., Dimmock, J., Pescud, M., Braham, R., & Rosenberg, M. (2016). Factors
affecting indigenous west Australians' health behaviour: Indigenous perspectives.
Qualitative Health Research, 26(1), 55-68.
https://s3.amazonaws.com/academia.edu.documents/39164970/Waterworth_et_al_2
015_Factors_affecting_indigenous_WA_health_behaviour.pdf?response-content-
disposition=inline%3B%20filename

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%3DFactors_Affecting_Indigenous_West_Austra.pdf&X-Amz-Algorithm=AWS4-
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The main aim of this study was to explore the Indigenous subjects' viewpoints of factors
that influence the health behaviour of society members. This study used an effective
participatory action research design alongside a grounded theory method, which is all suitable
methods for this kind of research. The study uses a sample of 120 members of 2 urban West
Australian Indigenous communities, which effectively took part in the discussions in the focus
group.
It was effective for the authors to use PAR methodology alongside a constructivist theory
strategy. The PAR methodological strategy effectively used both collaboration and consultation
with the involved communities in the research. It was effective for authors to consider the
community members alongside the subjects as co-researchers. This made them immerse fully in
the whole research process as members of the advisory committee and research assistants, thus
effectively guiding every step of the procedure as others were engaged in discrete parts. The
authors ensured active participation of all participants and hence directed the focus of
discussions leading to similar themes to answer the research objectives (Waterworth, Dimmock,
Pescud, Braham & Rosenberg, 2016).
The recruitment was valid based on PAR methodology alongside culturally suitable
involvement. This made it easy for advisory committees to guide the process and let the

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community research assistant perform the recruitment. Collection of data was effective because
it engaged eleven focus groups. The analysis was valid based on digitally recorded as well as
transcribed verbatim. The storage was also sufficient since the transcripts were properly
transmitted into NVIVO 10 software, which ensured that data was stored safely and analyzed
individually.
The main weakness is the small-focus groups of 120 people, which prohibits
generalization of the results. The greatest strength of the study is that the data was stored
effectively and independently analyzed.
Conclusion
This appraisal has shown that qualitative research is useful in carrying out research to
help reduce the health gaps in the Indigenous population in Australia. This analysis reveals that
there are available information and data that can be used to promote health amongst this group to
reduce the gaps.

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References
Hinton, R., Kavanagh, D. J., Barclay, L., Chenhall, R., & Nagel, T. (2015). Developing a best
practice pathway to support improvements in Indigenous Australians’ mental health and
well-being: a qualitative study. BMJ Open, 5(8), e007938.
https://bmjopen.bmj.com/content/5/8/e007938?
itm_content=consumer&itm_medium=cpc&itm_source=trendmd&itm_term=0-
A&itm_campaign=bmjo
Hinton, R., Kavanagh, D. J., Barclay, L., Chenhall, R., & Nagel, T. (2015). Developing a best
practice pathway to support improvements in Indigenous Australians’ mental health and
well-being: a qualitative study. BMJ Open, 5(8), e007938.
https://bmjopen.bmj.com/content/5/8/e007938?
itm_content=consumer&itm_medium=cpc&itm_source=trendmd&itm_term=0-
A&itm_campaign=bmjo
Povey, J., Mills, P. P. J. R., Dingwall, K. M., Lowell, A., Singer, J., Rotumah, D., ... & Nagel, T.
(2016). Acceptability of mental health apps for Aboriginal and Torres Strait Islander
Australians: a qualitative study. Journal of medical Internet research, 18(3), e65.
https://www.jmir.org/2016/3/e65/
Puszka, S., Dingwall, K. M., Sweet, M., & Nagel, T. (2016). E-mental health innovations for
Aboriginal and Torres Strait Islander Australians: a qualitative study of implementation
needs in health services. JMIR mental health, 3(3), e43.

HEALTH ADVANCEMENT AND PROMOTION 12
https://mental.jmir.org/2016/3/e43/?
utm_source=TrendMD&utm_medium=cpc&utm_campaign=JMIR_TrendMD_0