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Location and population size

Identifying a Community and Key Characteristics 

Location and population size 

Indigenous Australians have a familial heritage and membership in the ethnic groups that lived in Australia before the British colonization. This community mainly includes the Aboriginal and Torres Strait Islander peoples of Australia (Arnaert et al., 2022). The Aboriginal and Torres Strait Islander people are the indigenous people in Australia. Indigenous people are not one group but also comprise the hundreds of the groups that have different types of languages, cultural traditions and histories (Gibson et al., 2020). In 2016, it was estimated that almost 798,467 Aboriginal and Torres Strait Islander people were in Australia, as it represents 3.3% of the total population of Australia. According to a report by Abs, 91 percent of Indigenous people have an Aboriginal, 4.8 percent are recognized as the Torres Strait Islander origin and 4.0% are Aboriginal and Torres Strait Islander origin. However, based on the ABS calculation in 2021, almost 881,600 indigenous people live in Australia (Danchin & Buttery, 2021). 

Geographic distribution

 Geographical aspect of the indigenous community in Australia

Figure 1: Geographical aspect of the indigenous community in Australia

(Source: aihw.gov.au, 2022)

Indigenous Australians live in all parts of the country, from the desert and remote tropical areas. Indigenous Australians tend to live in urban and regional areas rather than remote areas (Danchin & Buttery, 2021). Almost 38% of indigenous people live in the major cities and 44 percent of them live in the regional areas. However, almost 18 percent of this community still live in remote and very remote areas. 

Language and culture 

 Culture of Indigenous people

Figure 2: Culture of Indigenous people

(Source: aihw.gov.au, 2022)

Indigenous people have passed on the ceremony, culture, tradition and knowledge from one generation to the next through the performance, protection of the vital sites, the elders' teaching, storytelling and others. Cultural factors such as spirituality, land and community are vital for the emotional and social well-being of the Indigenous Australians (Australian Institute of Health and Welfare (AIHW, 2020). Almost 357,400 indigenous people were recognized as a homeland and 314,200 people were recognized with a tribal group, regional group and clan. One hundred thirty-five hundred people lived in the homeland (Guzys et al., 2021). However, the indigenous people are a major and crucial part of the Australian population. 

 Vaccination hesitancy

Figure 3: Vaccination hesitancy

(Source: Danchin & Buttery, 2021)

As per WHO definition, vaccine hesitancy is the delay in the acceptance or refusal of the vaccines despite the availability of the vaccination services that makes a barrier to the health promotion (World Health Organisation WHO, 1986). According to surveys, many communities and parents there have their own beliefs and fear about the vaccination and for this reason, they are not accepting the vaccination (Danchin & Buttery, 2021). Vaccine hesitant communities are a larger and more type of attentive group in comparison to other groups. The most common causes of vaccine hesitancy are categorized into three factors such as lack of confidence, lack of convenience and complacency are the main reasons for delaying the vaccination process. Different communities are concerned about the potential side effects of the vaccines and they believe that a vaccine could cause a disease that can be prevented (Edwards et al., 2021). 

Geographic distribution

 Vaccination hesitancy

Figure 4: Vaccination hesitancy

(Source: Happell et al., 2019)

However, this community has been chosen to highlight the vaccine hesitancy because the majority trend of vaccine hesitancy has been found among this community during the COVID 19 vaccination (Happell et al., 2019). Vaccine hesitancy is common for ATSI people as they have faced many traumatic events and barriers to accessing and supplying vaccines (abc.net.au, 2022). They have interpreted the misinformation that has changed a tool of protection into a tool of fear (Happell et al., 2019). The colonial history of indigenous people has driven the mistrust between the government and ATSI people. Different records have shown that the government scientists and officials have taken blood samples and organs of the indigenous people during the 1900s and 1800s and maybe applied them for the research and different experiments (Danchin & Buttery, 2021). This kind of research has affected the assimilation policy established by the government, where the ATSI people and children are forcibly eliminated from their parents and named white Australia (Gianfredi, Moretti & Lopalco, 2019). 

 Vaccination comparison between Aboriginal and other people

Figure 5: Vaccination comparison between Aboriginal and other people

(Source: Kaufman et al., 2022)

While the COVID 19 vaccine has been rolled out for the Aboriginal and Torres people who have started in phase 1B, they have decided to suspend the use of AstraZeneca due to the increased cases of the blood clots (Happell et al., 2019). Moreover, another factor of hesitancy is the continuing change in the advice regarding the vaccines and age groups. The message related to AstraZeneca and age groups keeps changing, which is confusing and a cause of worry among the indigenous community (Kaufman et al., 2022). There was a gap in the path of information that has been shared. The gaps in the information have enabled certain types of faith groups to target these indigenous people specifically in the regional areas with the low rates of vaccination. Other factors are that the indigenous health professionals and the medical services have been fast to keep the COVID out of the town that feels safe for the indigenous people (aihw.gov.au, 2022). The different experiences of racism within the healthcare system have created hesitancy while the closest vaccination availability is only present at the hospital, mass labs or with the unfamiliar GP (Kaufman, Tuckerman & Danchin, 2022). 

 Vaccination hesitancy

Figure 6: Vaccination hesitancy

(Source: Kaufman, Tuckerman & Danchin, 2022)

As per the news, the hesitancy is more prone among the indigenous people because of complacency, hesitancy and lack of the tailored public health messaging that may have hampered the local vaccination efforts, as have the issues with the securing sufficient mRNA vaccines. Not only that because of a lack of resources and acceptability, but the supply of the vaccines has also been interrupted and could not be supplied properly (poche.centre.uq.edu.au, 2022). It increases the lack of crisis in the vaccine availability. The Chair Professor of Aboriginal people has stated that there are many issues from the government not prioritizing the indigenous and Aboriginal people throughout the rollout (Machingaidze & Wiysonge, 2021).

Language and culture

They have also agreed that the indigenous people are at high risk and could not take action.  The professor also has mentioned that tailored messaging and outreach programs are most important to close the gaps in the vaccination (Kaufman, Tuckerman & Danchin, 2022). This community also feels that taking vaccines is not culturally safe and refuses the vaccines based on their own beliefs. Another issue is the lack of funding that may reduce the incentives that reflect the hard-to-reach communities to participate in the vaccination. This community has myths and misinformation about vaccines that may lead to vaccine hesitancy. Teenagers and older people are pushed to take the vaccines from the indigenous communities of Queensland but this vaccine hesitancy makes a barrier (Happell et al., 2019). 

Due to all the above barriers, the indigenous people are mostly prevented or prone to vaccine hesitancy and for this reason, this community has been chosen to recommend the possible strategies to combat this vaccine hesitancy among them (racgp.org.au, 2022). 

In order to work collaboratively with the indigenous people, the nurses need to show respect for the culture and beliefs of the indigenous people. The nurses can build confidence regarding vaccination through community engagement.  In these indigenous people, the nurses need to separate the target age group and use different techniques to communicate. They need to understand the cross-cultural aspect of this community (Reid & Mabhala, 2021). In order to close the gap of vaccination hesitancy, the nurses need to respect people and build trust between them. The starting point of partnership the nurses need to build up the trust to achieve equitable partnership. This community is diverse and this diversity requires to be appropriately represented (Happell et al., 2019). The nurses need to follow the effective communication strategies for giving education such as using visual aids, audio and mostly communicating in the local language. This communication strategy is interactive and clear to enable culturally appropriate ways of sharing the understanding and working (Kaufman, Tuckerman & Danchin, 2022).

Moreover, time and resources need to be invested by the nurses in making relationships and sustainability for the indigenous people. Certain evidence presents the partnership can strengthen the decision-making process and effective treatment. Through the partnership, the nurses can identify the root causes of vaccine hesitancy and then take inappropriate action (Kaufman, Tuckerman & Danchin, 2022). The partnership can reduce racism and have the greater ability to achieve the needs of the Aboriginal and Torres Strait Islander community via accessing the appropriate programs and services. Through a strength-based approach, the nurses can make partnerships with the indigenous community of Australia. 

The strength-based approach can help the nurses to work collaboratively with the indigenous people of Australia. The strength-based approach may allow the people to check themselves at their best to see their value. It can allow a person to move that value capitalize and forward on the strengths instead of highlighting the negative characteristics (Machingaidze & Wiysonge, 2021). It is also used on the individual level and problem-focused using deficit discourse. Strength-based approach is appropriate to work in the communities as it is a social work practice theory that enlightens the strengths and self-determination of people. In nursing practice, the strength-based approach is the approach to care in which the eight core values guide the nursing action, promoting empowerment, hope and self-efficacy (Machingaidze & Wiysonge, 2021).

Vaccination hesitancy

 Strength-based approach

Figure 7: Strength-based approach

(Source: Guzys et al., 2021)

This strength-based approach consists of six principles such as desires, talents, strengths, experience, resilience, weakness and needs as perceived by another.  By applying the strength-based approach, the nurses need to categorize the factors or causes that are mainly the cause of the vaccine hesitancy such as vaccine attributes, political factors and individual characteristics and attitudes (Guzys et al., 2021). In this community-level intervention, the strength-based approach facilitates the implementation of the science, communication and behavior that can improve the clinical efforts for addressing the vaccine hesitancy and supports the efforts of public health to increase the rates of vaccination. 

Although the community leaders and the health professionals have been ramping up the vaccination drives and fighting the hesitancy for protecting the communities from the present when the COVID hits (Guzys et al., 2021), health workers have been doing the different outreach as part of the six-week vaccination schedules or program that may involve the clients in the homes and setting up clinics. The health professionals have focused on the fly-in-fly model of sending vaccines and the healthcare workers into remote and regional areas (Guzys et al., 2021). 

The healthcare organizations have stated that they are working to combat vaccine hesitancy in the remote areas and vulnerable parts of the Northern Territory, where the health professional may be afraid of the COVID outbreak could have negative effects (Kaufman et al., 2022). The community organizations and government have been working hard to get messages to the indigenous communities including the information in the language and other formats culturally appropriate for helping them understand the risks. 

Conclusion

It can be concluded that vaccine hesitancy may cause adverse health effects on the indigenous people. The government needs to focus on this community and their fear or anxiety related to vaccination hesitancy. The challenges such as misinformation and myths need to be eliminated by giving education through effective campaigns. The nurses are in the main role of changing the attitude and concern of the indigenous people towards the vaccination hesitancy. They can encourage all people who have a negative attitude towards vaccine hesitancy and can guide them on how vaccines can help them to prevent fatal diseases. 

References

abc.net.au. (2022). How a tool of protection has been turned into a tool of fear for Indigenous communities. Abc.net.au. Retrieved 27 April 2022, from https://www.abc.net.au/news/health/2021-09-13/covid-19-vaccine-hesitancy-indigenous-communities/100451174.

aihw.gov.au. (2022). Profile of Indigenous Australians - Australian Institute of Health and Welfare. Australian Institute of Health and Welfare. Retrieved 27 April 2022, from https://www.aihw.gov.au/reports/australias-welfare/profile-of-indigenous-australians.

Arnaert, A., Di Feo, M., Wagner, M., Primeau, G., Aubé, T., Constantinescu, A., & Lavoie-Tremblay, M. (2022). Nurse Preceptors’ Experiences of an Online Strength-Based Nursing Course in Clinical Teaching. Canadian Journal of Nursing Research, 08445621211073439. https://doi.org/10.1177/08445621211073439

Australian Institute of Health and Welfare (AIHW). (2020). Australia’s health 2020. Australia’s health series no.17. AUS 221. Canberra: AIHW https://www.aihw.gov.au/reports- data/australiashealth

Danchin, M., & Buttery, J. (2021). COVID?19 vaccine hesitancy: a unique set of challenges. Internal medicine journal, 51(12), 1987-1989. https://doi.org/10.1111/imj.15599

Edwards, B., Biddle, N., Gray, M., & Sollis, K. (2021). COVID-19 vaccine hesitancy and resistance: Correlates in a nationally representative longitudinal survey of the Australian population. PloS one, 16(3), e0248892. https://doi.org/10.1371/journal.pone.0248892

Gianfredi, V., Moretti, M., & Lopalco, P. L. (2019). Countering vaccine hesitancy through immunization information systems, a narrative review. Human vaccines & immunotherapeutics. https://doi.org/10.1080/21645515.2019.1599675

Gibson, C., Crockett, J., Dudgeon, P., Bernoth, M., & Lincoln, M. (2020). Sharing and valuing older Aboriginal people’s voices about social and emotional wellbeing services: a strength-based approach for service providers. Aging & Mental Health, 24(3), 481-488. https://doi.org/10.1080/13607863.2018.1544220

Guzys, E., Brown, R., Halcomb, E. & Whitehead, D. (2021). An introduction to community and primary health care (3rd ed.). Cambridge UK: Cambridge University Press.

Happell, B., Platania?Phung, C., Scholz, B., Bocking, J., Horgan, A., Manning, F., ... & Biering, P. (2019). Changing attitudes: The impact of Expert by Experience involvement in Mental Health Nursing Education: An international survey study. International journal of mental health nursing, 28(2), 480-491. https://doi.org/10.1111/inm.12551

Kaufman, J., Bagot, K. L., Tuckerman, J., Biezen, R., Oliver, J., Jos, C., ... & Danchin, M. (2022). Qualitative exploration of intentions, concerns and information needs of vaccine?hesitant adults initially prioritised to receive COVID?19 vaccines in Australia. Australian and New Zealand Journal of Public Health, 46(1), 16-24. https://doi.org/10.1111/1753-6405.13184

Kaufman, J., Tuckerman, J., & Danchin, M. (2022). Overcoming COVID-19 vaccine hesitancy: can Australia reach the last 20 percent?. Expert review of vaccines, 21(2), 159-161. https://doi.org/10.1080/14760584.2022.2013819

Machingaidze, S., & Wiysonge, C. S. (2021). Understanding COVID-19 vaccine hesitancy. Nature Medicine, 27(8), 1338-1339. https://www.nature.com/articles/s41591-021-01459-7

poche.centre.uq.edu.au. (2022). Elders and teens from Queensland's Indigenous communities push back against vaccine hesitancy to boost immunisation rates. Poche.centre.uq.edu.au. Retrieved 27 April 2022, from https://poche.centre.uq.edu.au/article/2021/09/elders-and-teens-queenslands-indigenous-communities-push-back-against-vaccine-hesitancy-boost-immunisation-rates.

racgp.org.au. (2022). newsGP - Vaccination gap: Vulnerable communities left exposed as Omicron threatens. NewsGP. Retrieved 27 April 2022, from https://www1.racgp.org.au/newsgp/clinical/vaccination-gap-vulnerable-communities-left-expose.

Reid, J. A., & Mabhala, M. A. (2021). Ethnic and minority group differences in engagement with COVID-19 vaccination programmes–at Pandemic Pace; when vaccine confidence in mass rollout meets local vaccine hesitancy. Israel Journal of Health Policy Research, 10(1), 1-9. https://link.springer.com/article/10.1186/s13584-021-00467-9

World Health Organisation (WHO). (1986). Ottawa Charter for Health Promotion https://www.******o.who.int/__data/assets/pdf_file/0004/129532/Ottawa_Charter.pdf

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