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参与式研究与农村原住民社区控制的医疗组织:使用 CONSIDER 声明获得的经验教训。

Participatory research with a rural Aboriginal Community Controlled Health Organisation: lessons learned using the CONSIDER statement.

机构信息

Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Vic. 3280, Australia

Dhauwurd-Wurrung Elderly and Community Health Service, Portland, Vic. 3305, Australia

出版信息

Rural Remote Health. 2022 Feb;22(1):6740. doi: 10.22605/RRH6740. Epub 2022 Feb 8.

Abstract

CONTEXT

In Australia, Aboriginal Community Controlled Health Organisations (ACCHOs) are geographically proximal to where Aboriginal and Torres Strait Islander People reside and are valued for providing holistic and culturally safe primary health care. Partnering with ACCHOs in research is appropriate for redressing health inequities experienced by Aboriginal and Torres Strait Islander People, which includes a high burden of chronic disease. Historically, some approaches to Aboriginal and Torres Strait Islander health research have been unethical. Greater accountability in the research process, transparency in reporting, and use of culturally appropriate research methodologies are key recommendations to improving the ethical integrity of research. The need for strengthening the reporting of health research involving Aboriginal and Torres Strait Islander People and Indigenous peoples globally led to the development of the CONSolIDated critERia for strengthening the reporting of health research involving Indigenous peoples (CONSIDER statement), which is a synthesis of international ethical guidelines. This project report uses the CONSIDER statement to critically reflect on participatory research undertaken in partnership with an ACCHO in the rural context and to identify lessons of value for future research.

ISSUE

By using the CONSIDER statement as a tool for critical reflection, it was identified that processes used to establish a research partnership with an ACCHO were key to setting the research agenda, including identifying ethical issues, the needs of local Aboriginal and Torres Strait Islander People, and expectations from the research. The participation of Aboriginal community members throughout the entire research process was not only methodologically important but was also ethically appropriate. Research activities in this project included opportunities for Aboriginal community members to directly share their perspectives and experiences and develop local solutions to issues affecting them. Outcomes included evidence to support future funding applications, community-derived priorities that assisted with government reporting, and locally identified methods for addressing chronic disease management. Key to this was building the research capacity and capability of local Aboriginal community members, which also reflected the ethical principles of reciprocity and equity. This also provided opportunities for non-Indigenous researchers to learn from local Aboriginal community members and develop skills in culturally appropriate research.

LESSONS LEARNED

Using the CONSIDER statement was beneficial in enabling researchers to critically reflect on a participatory research project undertaken in partnership with a rural ACCHO. Researchers identified that participatory approaches can be used to generate research of relevance to local Aboriginal community members and their ACCHOs, and to support health service reporting, and future funding applications. Research timelines and activities needed to be flexible and adaptable, to allow for staff turnover and unforeseen events of cultural significance. Similarly, it is important for researchers to be receptive to change and open to learning. Although research partnerships are established on trust and mutual respect, it is recommended that greater formal provisions are required to protect the intellectual property of Aboriginal and Torres Strait Islander communities involved in research. These lessons are likely to be transferrable to other settings and are of value to researchers seeking to partner with ACCHOs in research.

摘要

背景

在澳大利亚,原住民社区控制的卫生组织(ACCHOs)地理位置靠近原住民和托雷斯海峡岛民居住的地方,其提供整体和文化安全的初级卫生保健服务的价值得到了认可。与原住民社区控制的卫生组织合作开展研究,对于纠正原住民和托雷斯海峡岛民所经历的健康不平等问题是恰当的,其中包括慢性病负担沉重。从历史上看,一些原住民和托雷斯海峡岛民健康研究方法是不道德的。在研究过程中加强问责制、报告的透明度以及使用文化上适当的研究方法,是提高研究道德完整性的关键建议。需要加强报告全球范围内涉及原住民和托雷斯海峡岛民以及土著人民的健康研究,这导致了《CONSolIDated critERia for strengthening the reporting of health research involving Indigenous peoples》(CONSIDER 声明)的制定,该声明是对国际道德准则的综合。本项目报告使用 CONSIDER 声明对在农村背景下与原住民社区控制的卫生组织合作开展的参与式研究进行批判性反思,并确定对未来研究有价值的经验教训。

问题

通过将 CONSIDER 声明用作批判性反思的工具,确定与原住民社区控制的卫生组织建立研究伙伴关系所使用的过程对于确定研究议程至关重要,包括确定伦理问题、当地原住民和托雷斯海峡岛民的需求以及研究的期望。在整个研究过程中,让原住民社区成员参与不仅在方法上很重要,而且在道德上也是恰当的。该项目的研究活动包括为原住民社区成员提供直接分享他们的观点和经验以及制定解决影响他们的问题的当地解决方案的机会。结果包括支持未来资金申请的证据、协助政府报告的社区确定的重点以及确定用于管理慢性病的当地方法。关键是要建立当地原住民社区成员的研究能力和能力,这也反映了互惠和平等的伦理原则。这也为非土著研究人员提供了向当地原住民社区成员学习和发展文化上适当的研究技能的机会。

经验教训

使用 CONSIDER 声明有助于研究人员对与农村原住民社区控制的卫生组织合作开展的参与式研究项目进行批判性反思。研究人员发现,参与式方法可用于生成与当地原住民社区成员及其原住民社区控制的卫生组织相关的研究,并支持卫生服务报告和未来的资金申请。研究时间表和活动需要灵活和适应性强,以适应员工更替和文化意义重大的意外事件。同样,研究人员需要乐于接受变化和学习。尽管研究伙伴关系建立在信任和相互尊重的基础上,但建议需要更多的正式规定来保护参与研究的原住民和托雷斯海峡岛民社区的知识产权。这些经验教训可能适用于其他环境,并且对寻求与原住民社区控制的卫生组织合作开展研究的研究人员具有价值。

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