Exercise as it relates to Disease/The power of re-establishing cultural identity when promoting health in Indigenous communities

This is a critique of the article: [https://onlinelibrary.wiley.com/doi/epdf/10.1071/HE06103 Parker E, Meiklejohn B, Patterson C, Edwards K, Preece C, Shuter P, Gould T. Our games our health: a cultural asset for promoting health in Indigenous communities. Health Promotion Journal of Australia. 2006;(17):103-8]

What is the background to this research?
Health promotion practitioners consistently face the issue of developing effective health promotion strategies to increase the heath of communities. The relevance of community and cultural background seems to be one of the most important factors that influences the success health promotion initiatives.

Indigenous Australians, or First Nation peoples are one of the most disadvantaged populations in the world. It is commonly acknowledged that health outcomes for this group are lower than their non-indigenous counterparts.

Understanding the cultural health status of Australian Indigenous peoples requires an understanding of the relationship between the colonisation of Australia, trauma, and its impact on health. The colonisation of Australia has had devastating repercussions on social, spiritual and physical health of Indigenous people,. The population decline, dispossession of land, physical ill-treatment and discrimination play a huge roll in the exponential rate of mortality and diseases prevalent in this population. This trauma, anger and pain still exist within Indigenous people today. As a result, predictable health outcomes such as alcohol abuse as well as other high frequency grief reactions can be seen as a coping mechanism. ,.

The underlying determinants of Indigenous health have been attributed to income, education, living situation and access to health services. However, the cultural factors of health including racism, loss of language, spiritual and emotional disconnectedness have recently received more attention. Further exploration into concepts such as Indigeneity, which is largely based on elements of cultural identity, has allowed us to understand how this can be negatively impacting on Indigenous health. The sense of belonging to one's own community, land and animals are viewed as inherently apart of self for Aboriginal people. Cultural identity is not solely access to culture, but also the right for cultural expression within societies institutions.

There is a multifactorial meaning of physical activity, supported by a theme of cultural identity. Therefore, interventions and health promotion in this population should embrace a more holistic view of health and well-being that challenges the disease orientated, Western Health science paradigm. The following critiqued paper explores a community driven health initiative that implements traditional games to mobilise and increase physical activity in a meaningful way.

Where is the research from?
This study is from the Health Promotion Journal of Australia, a well known and reputable journal. 'Our Games, Our Health' was developed with two communities in Cherbourg and Stradbroke Island (Queensland, Australia). Funding was applied through the two communities and the Queensland University of Technology, who had previous encounters and collaborations in the past.

Several of the authors have a track record of research in this particular area (Ken Edwards, Elizabeth Parker). Elizabeth has more of a public health and promotion background, whereas Ken has a record of specific Indigenous research including a book on traditional games which is heavily resourced in this program.

What kind of research was this?
This study was an intervention and program evaluation, namely a process evaluation design. The study also utilised a qualitative methodology, which includes direct observation, surveys and record keeping as data collection tools. . This is consistent with other heath promotion studies which have been found to commonly be impact followed by a combination of impact and process evaluation. Qualitative only studies however, only consisted of 8% of other studies in the last couple of decades.

What did the research involve?
The project was underpinned by holistic context in which Indigenous communities view health, centred on family, community and society. The project was structured through three interlocking stages: community engagement, community mobilisation and capacity building.

The aim of the project was to develop, implement and evaluate a community-based, multi strategy health promotion intervention that focused on men and the older population. However, it was realised that because of the difficult personal situations of the older men and elders, it may be more effective to redirect target to school kids. Furthermore, targeting the next generation may be a more effective strategy in changing the future of the population’s health.

A community forum was established at Cherbourg and Stradbroke island communities where they held workshops and allowed members to learn about traditional games. The games used were integrated from a book Chaoopadoo: Games from the Dreamtime. They are suited for a range of age groups including both friendly and competitive games. Duration of games is 10-30min.

What were the limitations?
This study was the first to explore this particular area meaning that the results are less formidable. Questionnaires and feedback tools have been shown to be less accurate measures of success. Furthermore, time and funding constraints, meant that only a limited evaluation could be done. More funding could have ensured a stronger pre-post test evaluation. The changes and adaptations the study underwent means that this study is not highly repeatable.

What were the basic results?
The researchers interpreted a positive outcomes experienced by all those involved. More than 200 children from two primary schools participated in the 16 month project. The traditional games were integrated into the school's curriculum through carnivals and daily physical activity education and cultural curricula. Results were evaluated through the use of written questionnaires and focus groups which included questions about satisfaction levels. Most people "agreed" or "strongly agreed" in the feedback. Enthusiastic uptake of the program by other communities demonstrates its potential for transferability. Sustainability can be seen in the schools, where the games are still played.

What conclusions can we take from this research?
Health promotion in Indigenous population is a complex and difficult process and what may seem successful in one community may not be effective in another. There is no 'one' right way to promote Indigenous Health, but it is highly important to address the key principles of community when promoting health in these communities. Suitable and appropriate measures need to be identified to justify the potential of Indigenous games to increase physical activity levels of Aboriginal people. The games however, proved effective in providing a culturally appropriate activity that would not only boost social capacity, but also possibly empower and re-establish cultural identity.

Other studies in this specific area have had inconclusive results, reinforcing the difficult nature of measuring success in health promotion. A 2010 study, testing the effectiveness of Traditional games in a Townsville community found no significance change in cultural connectedness and physical activity levels. This possibly suggests that even with an extensive testing, limitations associated with the data collections tools such as feedback and questionnaires may not accurately reflect the communities engagement. More studies need to be required that follow up with the community down the track may be a useful measure of sustainability.

Practical advice
It is important to involve the community as much as possible when designing and implementing health programs. Further research is needed in this area to explore the implications traditional games have on the long term health of Indigenous school children.Future research can use the present methodology as a framework but must make it specific to the targeted community. Future studies should ensure they have adequate funding and appropriate evaluation tools.

Further information/resources

 * Close the Gap report "Our Choices, Our Voices (2019)


 * Closing the gap: Strategies and practices for promoting social and emotional well-being in Aboriginal and Torres Strait Islander People (2013)


 * Impact and cause of illness and death in Aboriginal and Torres Strait Islander people (2011)


 * Yulunga: Traditional Indigenous Games (2008)


 * Indigenous Traditional Games