Our projects

Supported by $2.5 million in National Health and Medical Research Council funding, the Centre of Research Excellence in Urban
Indigenous Health will connect existing partnerships and infrastructure between UQ’s Poche Centre for Indigenous Health and IUIH.

The CRE is an opportunity to improve health outcomes, enhance models of care, and influence health systems impacting on the health and wellbeing of urban Aboriginal and Torres Strait Islander peoples. Key research areas of the CRE include a focus on issues requiring systemic change such as data linkage between primary and tertiary care, mental health services, hospital in the home, rehabilitation, cancer care, maternity care, and progressing technological advancements.

Dates: 2022 - 2026
Funding: National Health and Medical Research Council, worth $2.5m
Contact: James Ward

The high burden of non-communicable diseases (NCDs) disproportionally affects Low- and Middle-income Countries (LMICs), where 85% of premature NCD deaths occur. Maternal and child health is inextricably linked with NCDs and their risk factors, and maternal and child health and NCD service integration is recommended for efficient use of limited resources. Behavioural change interventions in the pregnancy and post-pregnancy periods, for tobacco and alcohol avoidance, healthy eating, and psychosocial support, can prevent and reduce the risk of NCDs in current and future generations. However, the implementation of this evidence base is insufficient especially in LMICs.

Our aim is to work with stakeholders and co-create tailored implementation strategies to support the delivery of NCD risk prevention and reduction interventions in antenatal (ANC) and postnatal (PNC) primary health care settings in Nepal. Our objectives are to:

1. Conduct a needs and assets assessment to identify potential barriers and facilitators to implementation of the proposed NCD risk reduction interventions for ANC and PNC primary health care settings, and state relevant implementation outcomes and performance objectives.

2. Tailor implementation strategies and adapt the proposed NCD risk reduction interventions to the Nepali context through an iterative co-creation process with relevant stakeholders and women during and after pregnancy.

3. Initiate NCD risk reduction interventions using tailored strategies and evaluate implementation, service and client outcomes in an effectiveness-implementation cluster randomized trial.

Taking a theory-driven implementation science and life course approach to reduce the risks for NCDs in young people and next generation, will contribute to the ongoing efforts directed at achieving the SDG 3.4; reducing health inequities; improving quality of life across the life course, and informing and advancing preventive health programs and policies, in Nepal and globally.

Dates:  April 2023 - March 2028
Funding: NHMRC Global Alliance for Chronic Disease, worth $1.2m
Contact: Abdullah Mamun, Kjersti Mørkrid, Lal Rawal, Meghnath Dhimal, Ane-Marthe Solheim Skar, Biraj Man Karmacharya, Harold McIntyre, Abha Shrestha, Tor Strand, Zanfina Ademi

Adverse Childhood Experiences and Problematic Health Outcomes Over the Life Course of First Nations people.

The epidemiology of adverse childhood experiences (ACEs) among Aboriginal and Torres Strait Islander peoples is not well-known. What works to prevent or mitigate ACEs and promote positive outcomes for those who have experienced ACEs is also unclear. Understanding ACEs can contribute to the design of early prevention and timely management strategies.

The aim of this study is to understand biological, social and lifestyle mechanisms linking ACEs and problematic health outcomes over the life course in First Nations peoples. Through this study we will also develop culturally appropriate toolkits to support health practitioners, families, and communities for early management of ACEs.

We explored the challenges in screening for ACEs in antenatal care settings and to provide the lessons learned and evidence that guides the practice of ACE screening for both healthcare providers and pregnant women. A study on screening for ACEs in antenatal care in both public and private settings is needed to examine its feasibility and acceptability in the Australian context before being included in the National Perinatal Data Collection.

This project is a collaboration between UQ Poche Centre and Queensland Health. This grant is led by A/Prof Abdullah A Mamun.

A 12-year study on Type 2 Diabetes in the Inala Southern Queensland Centre of Excellence

Funded through the MRFF Indigenous Health Research Scheme, the Inala Diabetes Care (INDICARE) Study describes type 2 diabetes (T2D) prevalence and management in patients attending The Inala Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care over a twelve-year period (2010-2022).

INDICARE is a longitudinal data-linkage of patients’ electronic medical records, hospital admissions, emergency department presentations and medication items.

The study results will assist health practitioners, allied health professionals and Inala community to identify culturally appropriate, effective interventions and strategies to further improve the management of T2D.

These strategies would be likely to apply to Indigenous peoples across the nation, and especially those living in urban areas. Research Ethics approvals were granted at the end of 2022.

In partnership with Inala, the UQ Poche Centre research team under A/Prof Federica Barzi is progressing with the data linkage. Statistical analysis of the linked data will commence in 2023.

(RAUGH) brings UQ together with two of the country’s largest urban health services aiming to deliver an innovative, transdisciplinary co-design of feasible, whole-of-health-system approaches to eliminate inequities in service access and provision and outcomes for Indigenous peoples in Southeast Queensland.

Current research projects include the Hospital in the Home (HiTH) project, “Digital Infrastructure For improving First Nations matERNal and Child hEalth (DIFFERENCE)”, a Digital Infrastructure Project, and “Multidisciplinary co-design of innovative,
client-centred models for Indigenous mental health services in South East Queensland”, a Mental Health project.

This project is supported by NHMRC and MRFF Project Grants. Profs James Ward and Roxanne Bainbridge lead the RAUGH research program.

An Aboriginal community-led exercise and nutrition program offered to Indigenous pregnant mothers and to other mothers pregnant with an Indigenous baby.

Mothers participating to DFM will be cared for by a team of health professionals assisting with various mother’s health requirements and wishes during and after pregnancy. With this study we are hoping to show that DFM will help mothers to have a healthy pregnancy and a healthy Indigenous baby.

Disparities in maternal and infant health (MIH) persist between Indigenous and non-Indigenous Australians, despite clear national targets set in the 2008 Closing the Gap Strategy. Women giving birth to an Indigenous baby in metropolitan Brisbane have high rates of overweight/obesity (48%), gestational and pre-existing diabetes (13%), smoking (35%) and psychological distress (38%). These factors are associated with greater risk of adverse birth outcomes and of chronic diseases later in life in mums and offspring. Best practice primary prevention and management strategies perinatally are the promotion of lifestyle modifications that focus on increased physical activity and healthy diet.

The Deadly Fit Mums (DFM) is an Aboriginal community-led program delivered in greater Brisbane. It is an exercise and nutrition education program offered perinatally to women birthing an Indigenous baby through the Birthing into Our Community program. DFM is led by an accredited exercise physiologist and delivered in partnership with a multidisciplinary team of allied health professionals. DFM is tailored to the mums’ and families’ goals, needs and preferences.

Our objectives are to:
1. systematically scale up DFM services across greater Brisbane and measure fidelity of the program.
2. implement a quantitative study to evaluate efficacy of the DFM program by measuring and analysing clinical and behavioural indicators among participants of the program.
3. conduct qualitative research to determine acceptability of DFM programs among participating families and feasibility of implementing DFM among program staff.
We anticipate that participation in the DFM program, will lead to an improvement in modifiable MIH health determinants including healthy diet, physical activity, healthy weight and smoking cessation. This project will identify a best practice model of perinatal care for mums and their families, with a long-term vision to upscale DFM nationally.

Dates: 1 January 2023 - 31 December 2026
Funding: 2021 MRFF Maternal Health and Healthy Lifestyles, worth $1.8m
Contacts: Federica Barzi, Victor Oguoma, Carmel Nelson, James Ward, Amanda Lee, Jude Dean, Abdullah Mamun, Katrina Ghidella, Kristie Watego, Keane Wheeler, Jonathan Leitch

Graduate research project

Obstructive Sleep Apnoea (OSA) is a highly prevalent yet under-recognised health condition affecting many First Nations peoples. Logistical and financial issues in accessing non-local specialist services result in high rates of undiagnosed/untreated OSA in First Nations communities. This project includes five work packages focused on co-designing OSA services, upskilling the local workforce and educating community members to bring a transformative shift in OSA care in First Nations communities.

Obstructive Sleep Apnoea (OSA) in First Nations communities is highly prevalent, resulting in an increased risk of cardio-metabolic and mental health issues, productivity loss and accidents. However, most OSA cases in First Nations communities remain undiagnosed/untreated due to the unavailability of specialist services in local communities.

Considering the close link between OSA and chronic conditions and high rates of OSA in people aged 50 years or over, timely and culturally appropriate OSA care will be critical for reducing the risk/worsening of chronic conditions and healthy ageing in First Nations communities. Therefore, local services are crucial for timely diagnosis, management and continuity of care.

Leveraging the clinical expertise of nurses and Aboriginal Health Workers (AHWs) and building on pilot work, this project offers a culturally safe and holistic model for local OSA care in First Nations communities in rural, remote and regional Queensland. The program-LYAS-OSA is rooted in community engagement, integration of traditional and cultural knowledge and local capacity/capability building. The program encompasses five work packages aiming to integrate best-practice care in service delivery, co-designing service model and educational/awareness resources, training and upskilling nurses and AHWs for offering local (home-based) diagnosis and management, and embedding the co-designed model in regular service delivery. Program evaluation will help identify opportunities for model improvement and systemisation.

The training and upskilling of nurses and AHWs will develop local capacity and contribute to building a skilled workforce, while community awareness and understanding of OSA will enable a social environment to discuss OSA without shame and ensure timely uptake of services. Timely diagnosis and management of OSA will help improve cardio-metabolic and mental health outcomes and reduce the associated human and economic costs in First Nations communities.

One in three Aboriginal and Torres Strait Islander adolescents struggle with poor sleep, yet their sleep health needs remains unmet. In collaboration with community members, the project team and partner organisations are working together to co-design a sleep health program and resources, build local capacity, and embed culturally responsive and context responsive sleep health care in preventive programs and health system to meet the sleep health needs of First Nations adolescents.

The factors driving sleep health inequity in First Nations communities are 1) lack of holistic sleep health programs and resources rooted in First Nations peoples’ knowledge and ways of life, and 2) local capacity and capability issues affecting culturally responsive sleep health care.

Responding to these unmet needs and service gaps, we have partnered with leading Australian organisations spanning preventive health (Beyond Blue, Sleep Heath Foundation), community health/school (Young People Ahead, Ngak Min Health) and the hospital sectors (Queensland Children's Hospital) to meet the sleep health needs of First Nations adolescents.

This partnership project will deliver four interconnected Work Programs to improve the sleep health of First Nations adolescents. The research team and partner organisations will work with community members to co-design a sleep health program for First Nations adolescents, "Sleep for Strong Souls" (3S program), train First Nations peoples as "Sleep Coaches", and embed culturally appropriate and context responsive sleep health care in preventive programs and Australian health system. The partnership work will result in empowering First Nations adolescents to embrace sleep health and equipping service providers with right tools to deliver culturally responsive sleep health care.

Given the cross-cutting impact of sleep on all aspects of life, investing in the sleep health of First Nations adolescents will lead to significant downstream improvement in not only their social and emotional wellbeing but overall health and productivity and help them live life to its fullest potential.

Dates: 2023 - 2026
Funding: NHMRC Partnership Projects PRC1
Contact:  Yaqoot Fatima

An Aboriginal community-led program implemented in Brisbane.

BiOC’s initial outcomes were published in the Lancet Global Health (2021), showing a 50% reduction in pre-term births, plus improvements in healthy weight babies, antenatal visits and exclusive breastfeeding. Our team will extend the reach of BiOC to cover South East Queensland. We will follow three cohorts of families (n=~1800) across three BiOC services to assess clinical outcomes and program acceptability. Further, we will evaluate scalability, sustainability, feasibility and cost effectiveness of this ‘gold standard’ program. Our goal is to build an evidence base that supports a national roll out of BiOC in urban Indigenous communities.

Dates:  2022-2027
Funding:   MRFF, worth $5m
Contacts: James Ward, Federica Barzi, Judith Dean, Birri O’Dea

A desire to better explain the longstanding disparity in sexually transmissible infections (STIs) and blood-borne viruses (BBVs) among Aboriginal and Torres Strait Islander peoples led to the development of the ATLAS network.

ATLAS was developed in partnership with the Aboriginal Community-Controlled Health Organisation (ACCHO) sector in five clinical hubs, spanning the Kimberley in Western Australia, Cape York in Queensland, urban Brisbane, New South Wales and South Australia. Currently 32 ACCHOs are partners in the collaboration.

ATLAS was designed to address difficulties readily accessing and analysing patient-level service data, as well as to fill gaps regarding testing, treatment and ongoing management information in the Australian National Notifiable Diseases Surveillance System.

The ATLAS network links deidentified clinical data within and between participating sites and returns service-specific reports describing STI and BBV screening, positivity, treatment completion and outcomes to ACCHOs on a regular basis.

In the current funding period, we aim to double the number of participating ACCHOs, link with other primary care providers and add new regions to the ATLAS network. We also plan to expand the scope of the data infrastructure, to include vaccine-preventable diseases and chronic diseases.

The ATLAS network supports the capacity of ACCHOs to provide high quality, evidence-based, best practice clinical care for improved health outcomes for Indigenous peoples.

Activity to expand ATLAS and develop programs that transform clinical outcomes, while strengthening Indigenous governance and research capacity, will exponentially increase the utility and sustainability of Australia’s only comprehensive Indigenous primary care surveillance network.

Dates: 2021 – 2023
Funding: Australian Government Department of Health; $910,000
Contacts: James Ward, Clare Bradley

Meet the team

Data Science Traineeships

ATLAS Briefing

Internationally, primary health care (PHC) systems experience challenges of delivering quality care to growing populations with complex care needs.

The Institute for Urban Indigenous Health, which is a regional network of Aboriginal Community Controlled Health Services in South East Queensland, has overseen substantial increases in uptake of care in their clients, with demonstrable improvement in health outcomes.

However, evidence is emerging of the inability of the system to effectively respond to rapid population growth, necessitating a redesign of the way care is delivered.

Using a mixed methods approach, this prospective observational cohort study will evaluate a model of patient-centred medical homes, developed by an Alaskan Native-controlled health service and adapted to the local context.

Unique to this model is coordinated care that is delivered by a multidisciplinary team, rather than by individual clinicians. Embedded in Aboriginal governance, this study will examine: the feasibility and acceptability of implementing the model of care; whether compared to pre-implementation, this model of care improves access and relational continuity of care; longer-term health outcomes; and cost-effectiveness.

Research findings will deliver key lessons for: broader PHC system reform; system change management in real-world, PHC settings; Aboriginal led and governed models of research collaboration and distinct policy initiatives such as Health Care Homes.

Dates: 2020 - 2024 
Funding: Medical Research Future Fund (MRFF) (APP1200868); $1,209,747.00
Contacts: James Ward, Carmel Nelson, Lyle Turner, Adrian Carson, Leanne Coombe

Implementing a precision public health approach to move toward elimination of STIs, control of HIV and inform on other BBVs in regional Australia

Over the past 15 years, attempts to control STIs and BBVs using traditional public health approaches have provided some evidence about control approaches and impacts on population prevalence and incidence. However, more is required to shift the burden of disease.

Building on previous work, we now propose to trial a precision public health (PPH) approach which will focus on moving toward STIs elimination in the Cairns and Hinterland region of far north Queensland (FNQ).

The objectives include moving toward elimination of CT, NG, and infectious syphilis among Aboriginal and Torres Strait Islander people, and in parallel, reduce locally acquired cases of HIV in the Cairns region.

Other objectives include synergising data sets to contribute to a more complete picture regarding STI and BBV risk and applying this to designing strategies to be implemented across the region, as well as assessing outcomes, acceptability, and feasibility of a PPH approach in eliminating STIs.

This Indigenous led project will inform health services of activities for other BBVs, within the service catchment. The interventions within this project will focus on elimination of STIs in the region. This will be one of the first PPH approaches offered to control STIs nationally.

Dates: 2020 - 2025
Funding: NHMRC Ideas grant round, APP1185073, awarded $2,455,034.00
Contacts: James Ward, Clare Bradley, Stephen Harfield, Susan Jacubs

A multidisciplinary multi-phased study aimed at eliminating STIs in remote areas of Australia using a precision public health approach

For well over two decades, STIs have been endemic in many remote and regional communities in Australia - identified as the leading incident morbidity for Aboriginal people aged 10-24 years.

To address this problem, this project will utilise multidisciplinary research (i.e. epidemiology, genomics and qualitative research) and a precision public health approach.

Precision public health is an emerging field that uses multidisciplinary data to address public health issues for specific populations, rather than traditional public health approaches that focus on whole populations.

Data will be collated, synthesised and mapped locally to help inform precise public health interventions.

Working in select remote communities, this multi-phased study aims to eliminate STIs (defined as 50-90% reduction in incidence), eliminate congenital syphilis, improve management of blood borne viruses and enhance the delivery of healthcare services.

Expected impacts from this study include significant reduction in STI incidence and improvement in sexual health services.

Importantly, this study will be undertaken in partnership with a community coalition comprised of approximately 30 local community members. These coalitions will ensure that our research is truly developed, led and evaluated by local Aboriginal and Torres Strait Islander people.  

Dates: January 2021 - December 2026
Funding: NHMRC Synergy Grant (APP1185377), worth $5m
Contacts: James Ward, Clare Bradley, Salenna Elliott

Meet the team

Visit project page

Aboriginal and Torres Strait Islander people are identified as a key population for COVID-19 prevention and response.

However, there are concerns that messaging and preventative actions concerning COVID-19 are waning and will continue to decline, and community members will be become desensitised to new information.

Given there will be a need to have communication strategies for years to come, and Aboriginal and Torres Strait Islander people use social media readily to access health related information, the challenge remains how to develop consistent, enduring, meaningful and reinforced messaging about risk and response processes for Aboriginal and Torres Strait Islander communities to address both complacency and mistrust.

Using survey research methods to reach 600-1000 Aboriginal and Torres Strait Islander people, this study will investigate how COVID-19 messages (including vaccines) are received by communities, and meaningful ways to ensure communication is enduring and impactful over a longer period. 

Research findings will provide insight into the effectiveness of health messages and mediums used to communicate such messages to Aboriginal and Torres Strait Islander people during a pandemic or similar health crisis.

Dates: Oct 2020 - Dec 2021
Funding: Paul Ramsay Foundation, through the APPRISE CRE Collaboration, $79,000
Contacts: Shea Spierings, James Ward, Scott Trindall

The Eliminate hepatitis C Australia Partnership (EC Australia) was created in 2018 to bring together researchers, implementation scientists, government, health services and community organisations to ensure the whole of Australia sustains high numbers of people accessing hepatitis C treatment.

It is a three-year partnership project, funded by the Paul Ramsay Foundation and coordinated by Burnet Institute.

EC Australia’s goals are to:

• Ensure that 15,000 Australians with chronic hepatitis C are treated and cured of their infection annually
• Ensure that people identified with cirrhosis related to hepatitis C infection are treated and cured, and regularly reviewed to monitor for liver cancer
• Establish a national collaborative framework to facilitate a coordinated response to the elimination of hepatitis C as a public health threat from Australia by 2030.

In the first two years of operating, EC Australia has:

• Conducted a national state-by-state consultation to work with key organisations and state-run viral hepatitis committees to understand the current gaps in funding and workforce capacity across all jurisdictions
• Distributed funding for 18 workforce development projects to increase resourcing for the hepatitis C elimination effort
• Published Australia’s first national report on progress towards the elimination of hepatitis C virus in Australia, in partnership with the Kirby Institute. This report will be published annually to track Australia’s progress towards hepatitis C elimination targets.

Dates: 2018 – 2022
Funding: Paul Ramsay Foundation
Contact: Troy Combo

Systems thinking focuses on the dynamic interaction, synchronisation and integration of people, processes and technology to understand an issue. Its process is iterative, holistic and enables multiple stakeholder groups to come together to better understand strengths and gaps in a system-wide response. This study uses systems thinking to explore urban Indigenous communities’ preparedness for COVID-19 in south-east Queensland.

Through workshops, this project will use participatory system dynamics (Community Based System Dynamics) and system thinking’s causal mapping tools to map the causal linkages and feedbacks showing urban indigenous communities engage with the social systems supporting their health and wellbeing.

This study aims to: Understand the interactions of urban indigenous individuals and communities with social systems, including housing, health, education and Indigenous cultural events; Examine how these systems and interactions mitigate or protect the population during COVID-19 and other pandemics; and Identify where linkages and causal pathways exist within systems and interactions that can become leverage points for interventions meant to strengthen the system.

We will use the causal understandings and identified leverage points to synergise interventions and design better policy to address the vulnerabilities and protect the health of urban indigenous communities. Study findings will be reported widely to ensure other urban Indigenous communities’ benefit.

Dates: Oct 2020 - December 2021
Funding: Paul Ramsay Foundation, through the APPRISE CRE Collaboration, $107,000
Contacts: Bronwyn Fredericks, James Ward, Shea Spierings, Troy Combo

Harnessing the evidence from an urban First Nations health ecosystem to inform ongoing response, recovery and health system adaptation

Bringing together skilled First Nations researchers with policy, planning and service delivery expertise, this study will investigate and capture critical learnings gained during the COVID-19 pandemic.

Specifically, learnings will be drawn from a large urban community-controlled health “ecosystem” - the Institute for Urban Indigenous Health. 

Focused on First Nations-led responses to COVID-19 in an urban context, this study will use primarily qualitative research methods to explore the following research aims:

• To identify how an Indigenous-led approach compares and contrasts with mainstream and international First Nation responses and outcomes
• To prepare a strategy for, and undertake if circumstances determine, the documentation of the first few cases should an outbreak occur in SEQ among urban Indigenous peoples;
• Use case studies to investigate key aspects of service planning, response and reorientation, and community activation achieved during the current pandemic
• Identify strengths and gaps of the overall pandemic response within a large, urban regional CCHS network, using systems thinking methods.

This study will deliver an in-depth understanding of the critical success factors, any exigent challenges and key learnings from a large urban Indigenous health ecosystem pandemic response. It will have relevance for this and future pandemics as well as more broadly, for health system (both Indigenous-specific and mainstream) understanding, development and improvement;

The study will also provide practical tools and resources for dissemination, adaptation and adoption, as well as advancing individual and collective First Nations research knowledge, skills and career development.

Dates: Oct 2020 - Dec 2021
Funding: Paul Ramsay Foundation through the APPRISE CRE Collaboration, $169,000
Contacts: James Ward, Adrian Carson, Carmel Nelson, Lyle Turner