Researchers from the Faculty of Medicine and Health are involving the community in research to address health systems change.
We explore the work of Associate Professors Veronica Matthews and Danielle Muscat who are working with two distinct communities through research co-design.
Aboriginal and Torres Strait Islander led health solutions hold the key to addressing current health inequities. That’s why Associate Professor Veronica Matthews’ work is embracing Indigenous perspectives.
Based at the University Centre for Rural Health (UCRH) on Widjabul/Wyabul Country in Lismore, Veronica is incorporating environmental, social, and cultural determinants of health into research conducted alongside community.
Her work embraces a systems-thinking approach which encourages looking beyond immediate issues to consider root causes and long-term impacts to drive meaningful change.
Hailing from the Quandamooka community of Minjerribah (North Stradbroke Island), Veronica’s work is focused on improving holistic health care systems that combine health of Country with community and family as the two are inextricably linked.
“Thinking holistically and maintaining balance with our surroundings are at the core of First Nation’s culture,” says Professor Matthews.
Veronica believes that it makes intuitive sense that community should be leading research with place-based initiatives providing cultural integrity and ensuring that the Indigenous worldview prevails.
Associate Professor Veronica Matthews is incorporating environmental, social, and cultural determinants of health into research conducted alongside community.
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LinkHolistic healthcare, like that provided by Aboriginal and Torres Strait Islander community-controlled services, reflects the principles of respect, reciprocity, responsible care and balance. It’s a prescription that benefits all people, our non-human relatives and the planet upon which our health and wellbeing depends.
Veronica co-leads the Indigenous Knowledges theme within the Healthy Environment and Lives (HEAL) National Network and the Centre for Research Excellence in Strengthening systems for Indigenous health care Equity (CRE-STRIDE).
HEAL’s goal is to improve health quality through systems-thinking and community-based participatory research. Veronica believes we need to re-learn the holistic connectedness of systems that support life.
“Current systems govern health, the environment and communities in siloes. As an antidote, we require multisectoral collaborations, diverse knowledges, community leadership, and intergenerational thinking,” says Veronica.
“We urgently need inclusive climate action that addresses (not perpetuates) existing inequities, that strengthens and values First Nations’ culture and knowledges and works in respectful partnerships with Aboriginal and Torres Strait Islander communities.”
As part of HEAL, Veronica leads the Healing Country Project with the aim of creating community interactive, online story-data maps which consists of a blend of storytelling and statistics to showcase changes that First Nations people are witnessing.
The community stories and data will be housed on a software platform through which community maintains control over its use and distribution. Publicly available story-data maps will be displayed online, highly visual, and interactive to provide viewers a sense of what is occurring on Country.
Generating a thorough understanding of environmental risk, these maps will help communities to adapt to climate change. The data will also provide the evidence to government and other stakeholders about environmental problems and the solutions required to heal Country.
“The story-data maps are re-asserting Aboriginal communities’ rights and role as caretakers of Country. They reflect pre-colonisation processes, where Aboriginal and Torres Strait Islander people navigated the land based on their intimate knowledge of Sky, Land and Sea Country. These knowledges were shared through stories, dances and songlines, connecting communities from all corners of the country,” says Veronica.
In addition to this, the STRIDE collaboration is challenging the standard ideals of research practice, that are based on non-Indigenous paradigms.
Both collaborations bring together service providers, policymakers, and researchers to integrate Aboriginal and Torres Strait Islander knowledges and methodologies into inter-sectoral research, aiming to achieve health equity.
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Health literacy is the ability of individuals to access, understand, evaluate, and use health information and services to make informed decisions about their health, and it is something Associate Professor Danielle Muscat is passionate about.
Health literacy is a subject that Danielle began researching during her PhD. In it, she developed and evaluated a world-first health literacy program for Australian adults attending adult basic literacy courses at TAFE across New South Wales.
Danielle is now the Applied and Translational Research Lead of the Sydney Health Literacy Lab. Her work is focused on improving health literacy through the development, evaluation and scale-up of interventions at both community and systems levels.
This involves working with communities to improve their capacity to access, understand, evaluate, and use health information as well as changing the way the health system is designed to ensure that it is easy to understand and navigate and meets people’s health literacy needs.
“When we measure health literacy of individuals, around 60% of all Australians have low health literacy, meaning that they may struggle with common health tasks, such as reading instructions on a medication label. A disproportionate number of those with lower health literacy are from socially disadvantaged groups including older adults and those who speak a language other than English at home,” says Danielle.
From a systems perspective, we know that – more often than not – health information is written at a post-graduate level, much beyond the level of literacy of our patients. In this way, there is a mismatch between the health literacy of patients and communities and the complexity of our health systems.
In 2018, Danielle co-led the establishment of the NSW Health Statewide Health Literacy Hub, a partnership between the University of Sydney and NSW Health, NSW’s public health system which includes 226 public hospitals, over 180,000 staff and eight million residents.
Through the Hub, Danielle has focused on creating and scaling up systems which standardise the development of health information to ensure that it meets the needs of patients.
“A key initiative of the Hub is to scale-up – across the whole of NSW – an electronic system and process that supports health staff in producing easy-to-read health information through the provision of standard writing templates, automated readability assessments and tools for obtaining and incorporating consumer feedback,” says Danielle.
“We’ve been able to collaborate with health staff in Illawarra Shoalhaven Local Health District to show the system is effective, user test that in western Sydney, pilot in Northern NSW and now scale across NSW. Partnerships have been key at every stage to make change happen and translate research into real-world health settings.”
Associate Professor Danielle Muscat is the Applied and Translational Research Lead of the Sydney Health Literacy Lab at the University of Sydney.
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LinkDanielle and her team have also worked with communities to co-design a number of programs to build people’s health literacy. This includes the STEPs stillbirth prevention program for newly arrived migrants, delivered by midwives and multicultural health team members in Westmead and Blacktown, and the Parenting+ program for parents with a baby under 6 months.
"The STEPs stillbirth prevention program has been designed to support migrant women understand information related to stillbirth prevention, to access the health care system when they need to – for example, when they stop feeling their babies’ movements – and engage in shared decisions about their health," says Danielle.
They are also currently partnering with Baabayn Aboriginal Corporation - to co-design a model of health literacy that is culturally safe and responsive for Aboriginal communities and a health literacy program for mums and bubs.
In 2021, Danielle was part of a team that surveyed 708 culturally and linguistically diverse participants in Greater Western Sydney to learn about how they sought information about COVID-19. It’s a geographical area where 47% of residents are overseas-born and one in two speak a language other than English at home.
In the University of Sydney study, the team found that non-English speakers had greater difficulty finding easy-to-understand COVID-19 information. Their research led to a local COVID-19 initiative promoting testing and vaccination with culturally tailored messaging, influencing the state response and gaining national and international recognition for managing outbreaks in diverse communities.
Danielle and her team have worked with communities to co-design a number of programs to build people’s health literacy, including the Parenting+ program for parents with a baby under 6 months.
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LinkPartnering with NSW Health has enabled me to answer research questions that are important to clinicians and communities. In my experience, getting it right in these real-world settings has really laid the foundations for national and global impact.
The Faculty of Medicine and Health unites various disciplines, including biomedicine and medical sciences, dentistry, health sciences, medicine, nursing and midwifery, public health, and pharmacy, under a single faculty. It aims to foster innovation, promote excellence, and advance a strategic vision across teaching, research, and clinical practice.
The work undertaken by Veronica and Danielle is supported by faculty leadership. In particular, Professor Meredith Makeham, Associate Dean (Community and Primary Health Care) and Rick Macourt, Associate Dean (Indigenous Strategy and Services) who help guide and enable academics to contribute to their communities through research.
Meredith has a strong interest in health systems and is the faculty lead for the Community and Primary Health Care Strategy 2022-27 and the Community and Primary Health Care Network.
“Our work to put primary health care principles including person-centred care into the way we deliver world class education and research is at the heart of everything we do," says Meredith.
"Initiatives like our consumer partnerships and developing a consumer engagement framework to drive impactful research are examples of this.
"Our healthcare professional students’ engagement with important community groups such as the WentWest Primary Health Network’s “Citizen’s Assembly" is another example of the importance we place on partnering with consumers and prioritising the needs of the communities we serve."
Our students are actively working with community groups, reflecting our commitment to partnering with consumers and serving community needs.
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LinkRick is a firm advocate for committing to a healthier future for and with Aboriginal and Torres Strait Islander communities through faculty strategy and engagement.
“First Nations peoples, of which Western Sydney has the largest population in the nation, hold the keys to the challenges that have been systemically embedded in our systems of education and health," says Rick.
"Self-determination requires that we stop, reconsider whether the distribution of decision-making power is just, and that we invite Aboriginal and Torres Strait Islander peoples to the table when it comes to research, policy-development, health practice and more."
Researchers at the Faculty of Medicine and Health are engaging with communities to drive impactful research.
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