�009 vol. 33 no. 1 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH �1© 2009 The Authors. Journal Compilation © 2009 Public Health Association of Australia

Engaging with Aboriginal communities in an

urban context: some practical suggestions for

public health researchers

Abstract

Objective: In this paper, one Indigenous

and two non-Indigenous public health

researchers reflect on our combined

experience of over thirty years in Aboriginal

health, in order to develop some practical

guidelines, particularly for researchers

working with urban Indigenous population

groups.

Approach: Public health research is

important not only to address the health

inequities experienced by Australia’s

Indigenous populations, but also to build

knowledge and confidence and to inform

practice in Aboriginal community-controlled

health organisations. Ethical guidelines and

previous research experience demonstrate

that researchers need to engage with the

communities that may be involved in or

affected by the research they propose.

Although more than half of Australia’s

Aboriginal and Torres Strait Islander

population live in urban and regional

centres, most research and commentaries

address the health and social issues

of remote communities. Researchers

often do not know how to engage with

urban Aboriginal communities and how

to approach the particular research

challenges within this context.

Conclusion and Implications: The

practical guidelines suggested in this paper

may assist public health researchers to

conduct ethical health research that is

planned and carried out in a culturally

appropriate way and that will benefit urban

Aboriginal people. While not intended to be

prescriptive, we believe that the lessons

learned in Victoria will be applicable to

other urban Indigenous contexts around

Australia.

Aust N Z Public Health. 2009; 33:51-4

doi: 10.1111/j.1753-6405.2009.00338.x

Priscilla PyettOnemda VicHealth Koori Health Unit, Centre for Health and Society, School of Population Health, University of Melbourne, Victoria

Peter Waples-CroweVictorian Aboriginal Community Controlled Health Organisation, Victoria

Anke van der SterrenCentre for Health and Society, School of Population Health, University of Melbourne, Victoria

Although more than half of Australia’s

Aboriginal and Torres Strait Islander

population live in urban and regional

centres, most research and commentaries

address the health and social issues of remote

communities which account for only one

quarter of the total Indigenous population.1

For example, in Victoria, the Aboriginal and

Torres Strait Islander population is estimated

at about 31,000 with more than half living in

and around Melbourne.2 Outside Melbourne,

Aboriginal people live in and around large

urban centres like Shepparton, Mildura and

Bairnsdale, and around smaller urban centres

like Horsham, Swan Hill, Robinvale and

Portland. In this paper, we use Indigenous

or Aboriginal to refer to the Aboriginal and

Torres Strait Islander peoples in Australia.

We recognise the diversity of Australia’s

Indigenous population and that different

groups and communities within this population

choose to refer to themselves by different clan,

group or tribal names. Like other Aboriginal

and Torres Strait Islander people throughout

Australia, Victoria’s Indigenous population

experiences higher rates of chronic illness and

premature mortality than the non-Indigenous

population.2 Despite some improvements over

recent decades, babies born to Aboriginal

Submitted: June 2008 Revision requested: October 2008 Accepted: December 2008Correspondence to:Dr Priscilla Pyett, Senior Research Fellow, Onemda VicHealth Koori Health Unit, Centre for Health and Society, School of Population Health, University of Melbourne, Victoria 3010. Fax: 03 8344 0824; e-mail: pmpyett@unimelb.edu.au

mothers in Victoria are still more than twice

as likely to have a low birthweight (17%

cf 7%); Aboriginal Victorians also die at a

younger age and have higher rates of hospital

admission; the major causes of admission

are renal dialysis, respiratory and circulatory

diseases, mental disorders and for women,

pregnancy-related admissions.3

A network of 27 Aboriginal community-

controlled health organisations (ACCHOs)

across Victoria provide a range and mix of

services depending on the size and expressed

needs of the local Aboriginal community, and

the degree to which the service is resourced.

Aboriginal community-controlled health

organisations are unique in Australia. They

are incorporated, community-controlled

services committed to a holistic approach to

health care, responding to the needs of the

community, and community participation in

decision-making. Arising in the early 1970s

as part of a movement responding to a lack

of adequate, appropriate and good-quality

services for Aboriginal people, ACCHOs

were established to address the social,

cultural and practical barriers that inhibited

many Aboriginal people from seeking health

care. The first ACCHOs in Victoria were

established from the early 1970s, and over

Article Indigenous health

�� AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH �009 vol. 33 no. 1© 2009 The Authors. Journal Compilation © 2009 Public Health Association of Australia

time, many local Victorian communities have established their

own health services or co-operatives offering a range of different

services according to local needs and resources. While some are

dedicated health services, most include a range of other cultural

and support services.

ACCHOs have an annually elected Aboriginal Board, a majority

of Aboriginal staff and management, and the power to hire and

fire non-Aboriginal staff. Aboriginal Health Workers are integral

to service delivery. As community-controlled spaces they are a

central component of self-determination and cultural continuation

within Aboriginal communities.4

In order to explore ways of improving the health status of

urban Indigenous populations, public health researchers need

to understand and respect the philosophy of community control

practised in ACCHOs. Community control is a fundamental

principle of self-determination, and is codified in the United

Nations Declaration on the Rights of Indigenous Peoples.5

Research is important to build knowledge and confidence within

Aboriginal community organisations and to inform practise in

ACCHOs. Researchers need to engage with the communities

that may be involved in or affected by the research they propose.

As one Indigenous and two non-Indigenous researchers with a

combined 30 years of experience in Aboriginal health, we have

found that researchers very often do not know how to engage with

Aboriginal communities in an urban context. Compared to remote

and some rural communities, urban Aboriginal communities are

less homogenous, are not geographically discrete, and may not

have a single central community organisation or council that can

be referred to for guidance in research. This provides a challenging

environment for researchers. We therefore offer below some

practical guidelines that may assist public health researchers to

conduct ethical health research that is planned and carried out in

a culturally appropriate way and that will benefit urban Aboriginal

people. These suggestions are not prescriptive and many are also

relevant in research with non-urban Aboriginal people.

Allow extra timeFirst we reiterate the importance of understanding and accepting

the extra time that will be needed to develop relationships of

mutual trust.6 Not all researchers have the time or the patience

needed and few funding bodies or research institutions allow

sufficient time and resources for this essential aspect of research

with Aboriginal and Torres Strait Islander populations. Community

consultation has been recommended in policy documents and

ethics guidelines for research with Aboriginal and Torres Strait

Islander populations for several decades.7,8 It is now explicitly

required and supported by Australia’s major health research

funding body − the National Health and Medical Research Council

of Australia (NHMRC 2003).9 We advise that approval or support

for a project should only be sought after adequate consultation has

occurred. Too often researchers contact community organisations

with a research proposal requiring a letter of support so they can

submit it for funding or ethics approval, but they have not begun

to consult with any representatives of the relevant community.

How to consultLikewise, consultat ion needs to begin before the

research proposal is developed, and before it is submitted for

funding or for ethics approval. But what does consultation mean

in an urban context? How does a researcher find the relevant

community and how can they know who to consult with?

Remote communities can seem challenging for researchers

to approach, but they are geographically discrete and usually

have clear structures and protocols for consultation. Urban

Indigenous populations are more diverse and dispersed. The

structures and protocols are less clear to outsiders. In some cases

a researcher (whether they are Indigenous or non-Indigenous)

may already have networks and relationships within an Aboriginal

community and these are important. But, as in any other context,

researchers should be cautious about relying only on their own

friends or networks. It is essential to consult more broadly and in

an urban context this means finding the appropriate Aboriginal

organisation(s) that can represent the community and are likely

to have access to a broad range of community members and

opinions.

We suggest that researchers approach the peak body most

relevant to their topic for advice on who to consult for their

project, for example: education, housing, childcare, legal

services, or health. In Victoria, the peak body for Aboriginal

health is the Victorian Aboriginal Community Controlled Health

Organisation and other states and territories have similar

affiliates of the national peak body, the National Aboriginal

Community Controlled Health Organisation (NACCHO). The

peak body can recommend appropriate representatives of the

community. These may be individuals – an Elder, an official

spokesperson, or the CEO of a local organisation; or they may

be representative bodies – for example, the Boards or Executive

Committees of organisations. For health research this might be

one of VACCHO’s 25 member organisations. The peak body

might suggest that discussions with the specific community

organisation(s) should be undertaken only when funding is certain

(so as not to raise expectations that cannot be met). Ideally,

the research topic would be generated by the community or in

consultation with them.10,11 This would increase the relevance of

the research and the likelihood of findings being of benefit to the

community, as well as the level of interest from the community

in participating in the research.

Educate ourselvesBefore consultation begins, it is a researcher’s responsibility to

inform ourselves about the Aboriginal people and the communities

who will be included in or affected by our research.6 An ever-

increasing amount of quality information is available online now

and there are numerous significant cultural resources housed in

museums and keeping places in every state and territory. Likewise,

there is a great deal of information available on appropriate

and ethical research practice with Aboriginal communities that

researchers should be familiar with before approaching these

communities.

Pyett, Waples-Crowe and van der Sterren Article

�009 vol. 33 no. 1 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH �3© 2009 The Authors. Journal Compilation © 2009 Public Health Association of Australia

Indigenous health Engaging with Aboriginal communities

Involve Indigenous people in the research planning and implementation

Part of appropriate and ethical research practice includes

involving Indigenous people in research planning processes and the

implementation of the research project. Therefore, the consultation

process should include finding out how much the relevant

community wants to be involved in the research planning and other

processes and what their timelines are. Some communities may

wish to have a high level of involvement; others may not have the

time or the resources. Consider employing one or more Indigenous

co-researchers and people from the local community if they are

interested.12 Given the pressing health and social needs of their

client group, research is seldom a high priority for an Aboriginal

community organisation. If the project is community-initiated, or

if the community representatives support the idea of the proposal,

they may still prefer that the researcher develops the proposal,

using their specialised knowledge of research protocols and the

particular health topic. The community organisation should be

consulted for their specific knowledge of their own community,

the relevance of the research question and the appropriateness

of the research methods. Reciprocity needs to be built into the

project,9 and the budget should include the cost of any community

resources that may be needed for the project, including staff time,

and any organisational commitments to advisory processes. This

collaborative and participatory approach helps to redress what can

otherwise be an unequal power relationship between researchers

and Aboriginal people.

Communication throughout the projectKeeping the community informed of the planning process and

checking with them about all aspects of the research that will

affect their community is essential throughout the project.12 It

is not always easy to judge what is an appropriate and welcome

level of consultation and involvement, versus what may be seen as

unwelcome pestering for responses to every question at every step

along the way. The researcher should be guided by the community

and by the project steering committee (see below). Meetings that

are too frequent or too long and documents or reports that are

too long or wordy may be just an added burden for busy people.

An adequate and appropriate level and format for consultation

and feedback should be negotiated and written into the project

agreement (see below).

Establish a project steering committeeIn order to demonstrate respect for community control, as well

as to improve the appropriateness, relevance and validity of the

research, it is imperative to establish an Aboriginal-controlled

project steering committee (or reference group). This is a

mechanism to give Aboriginal people the opportunity to contribute

to, guide and monitor the project. Researchers are often quite

rightly anxious about who should sit on such a committee and how

to ensure that it is representative of the relevant community. In our

experience, we have found it useful to begin by identifying two or

three Aboriginal stakeholders and ask them to nominate a range

of representatives from relevant organisations or communities. At

the first and possibly subsequent meetings, the members can be

asked if they feel there is anyone else who should be invited to join

the steering committee. However, too many changes in committee

membership can introduce conflicting advice, so it is advisable to

establish a consistent membership early in the project.

Formalise the relationship through a project agreement

Relationships between researchers and community organisations

can be formalised through a Project Agreement or Memorandum

of Understanding (MoU) that is developed as an agreement

between the partners engaging in a specific project. Although not

legally binding documents, these provide a written record of the

expectations and commitments each person and each organisation

has and can be useful in avoiding or resolving disputes. The

principles on which the agreement is based should include a

statement to the effect that ‘Aboriginal peoples have a fundamental

right of ownership over their own knowledge and information’

as well as detailing processes for consultation, collaboration and

communication throughout the project. The agreement should

also address likely outcomes of the project, how results will be

disseminated, who will be the authors and how the community

will be acknowledged in publications. Many of these questions

are addressed in ethical guidelines for research with Aboriginal

and Torres Strait Islander peoples from both an academic and a

community perspective.9,13

Ethical reviewIdeally, all research proposals would undergo a process of ethical

review by an Indigenous ethics committee to ensure it is culturally

appropriate and sensitive, and will cause no harm. Unfortunately,

there are very few Aboriginal ethics committees in Australia and

very few Human Research Ethics Committees (HRECs) with

Indigenous members, although some Indigenous subcommittees

are attached to HRECs and some HRECs employ other strategies to

ensure that projects are assessed by an Indigenous reviewer.14 Some

organisations such as the Australian Institute of Aboriginal and

Torres Strait Islander Studies (AIATSIS), and various University

Indigenous Centres have developed their own guidelines.7,8 The

NHMRC Values and Ethics9 are built around six core values:

reciprocity, respect, equality, responsibility, survival and protection

and spirit and integrity, and it is the responsibility of researchers to

familiarise ourselves with these principles and their applicability

to our research. Any registered HREC will require researchers to

address these core values. In addition, if there is no Indigenous

ethics committee or subcommittee assigned to review the research,

the community organisation may have a process for submitting

the proposal to its Board or Executive or to an ethics panel.

This additional step in the process of ethical review may seem

burdensome to a researcher keen to get on with a project, but the

involvement of Indigenous reviewers may identify problems that

can be addressed before the research goes into the field. There

are specific ethical issues relating to Indigenous research that

�� AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH �009 vol. 33 no. 1© 2009 The Authors. Journal Compilation © 2009 Public Health Association of Australia

may be best addressed by the project steering committee. For

example, due to the small size of the population, communities

and individuals may be identifiable even if they are not named.

The advice of the project steering committee should be sought

to ensure that the confidentiality of communities as well as of

individuals is protected.

AcknowledgingAboriginal co-investigators, research off icers, research

assistants, project officers, project steering committees or other

contributors to the project should be appropriately acknowledged

for their contribution to the project and as co-authors wherever

possible and appropriate. The way researchers acknowledge our

participants, the communities we consulted and the people who

carried out the research is an important part of reporting the

processes of consultation and community engagement. Failure

to report these processes raises questions about the legitimacy

and validity of the research. Far too few researchers do this as

evidenced in a recent literature review. A systematic review of

epidemiological studies of Australian Indigenous child health,

development and wellbeing conducted in 2006 found that 71.5%

of the 214 studies identified did not report whether Indigenous

people had been involved in the research process (other than as

participants).15

ConclusionWe have drawn upon our own research experiences and have

presented a number of practical guidelines for research with urban

Aboriginal communities. These are not intended to be prescriptive

and indeed a degree of flexibility and simply ‘feeling your way’

is necessary in community-based research. We believe that the

lessons learned in Victoria will be applicable to other urban

Indigenous contexts around Australia.

AcknowledgmentsPriscilla Pyett was supported by a VicHealth Public Health

Research Fellowship; Anke van der Sterren was supported by a

NHMRC Training Scholarship for Indigenous Health Research, a

CRC for Aboriginal Health Top-Up Scholarship, and a VicHealth

Public Health PhD Research Grant.

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for Aboriginal and Torres Strait Islander Patients Program (ICAP) Melbourne (AUST): State Government of Victoria; 2007.

4. Department of Health and Ageing. General Practice in Australia: 2004. Canberra (AUST): Commonwealth of Australia; 2005.

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Pyett, Waples-Crowe and van der Sterren Article