This project examines the cost-effectiveness of an integrated community development approach for reducing alcohol-related injury and violence among Aboriginal people in three rural locations in NSW. The approach comprises three core program components which are designed to reduce the opportunities for alcohol harm to occur, to increase people’s sense of empowerment and to better utilise the existing services in the communities. This project shows a new way of combining local, Aboriginal expertise with the evaluation expertise of academics.
Mrs Bonita Byrne (NDARC, based in Narrandera)
Mr Jamie O’Neill
Lower Lachlan Community Services
Associate Professor Melissa Haswell-Elkins
Muru Marri Indigenous Health Unit, UNSW
Griffith Aboriginal Medical Service
Professor Christopher Doran
Hunter Medical Research Institute, University of Newcastle
Dr Anton Clifford
School of Population Health and Community Medicine, University of Queensland
Community members and community based organisations in three towns in regional NSW (e.g. city councils, police, hospital, health, family and youth organisations).
Aboriginal Australians experience a disproportionately high burden of alcohol-related injury and violence compared to the general population: alcohol-related violence is 6 to 9 times higher for Aboriginal males and up to 6 to 20 times higher for Aboriginal females, compared to the general Australian population. Injury and violence are two main contributors to alcohol-related mortality among Aboriginal Australians, which is a main contributor to the overall health gap between Aboriginal and non-Aboriginal Australians. These elevated rates of alcohol-related harm among Aboriginal Australians require a targeted approach. Evaluations of Aboriginal-specific alcohol interventions have typically been supply reduction or education strategies. Less than one quarter of published evaluations of alcohol interventions conducted in Aboriginal communities specifically targeted reductions in injury and violence and few were implemented in rural communities. Of those evaluations, few studies have employed randomisation or a comparison group in their methodology. As such, there is a need for rigorous cost-effectiveness evaluations of interventions targeting reductions in alcohol-related injury and violence in geographically diverse Aboriginal communities.
To quantify the cost-effectiveness of an integrated community development approach for reducing alcohol-related injury and violence among Aboriginal people in three rural locations in NSW.
More specifically, in all three target location, the intervention aims to:
- Reduce the proportion of Aboriginal people admitted to hospital for alcohol-related injury
- Reduce the proportion of Aboriginal people arrested for alcohol-related violence
- Reduce the proportion of Aboriginal people experiencing alcohol-related injury or violence
The approach is evaluated using a multiple baseline (interrupted time series) design. The three participating locations commenced the activities following each other with 3-5 month gaps. Baseline data on community level alcohol-related injury and violence was collected. Though the three core program components were the same across the three locations, the specific activities were identified and decided by a local implementation committee consisting of local Aboriginal community members and Aboriginal and non-Aboriginal service providers.
Activities specifically targeted young Aboriginal people and Friday and Saturday nights (i.e. times that are high risk for alcohol related harms to occur). Examples of activities include Midnight Basketball competition, cultural activities, talent show, touch football nights and the Family Wellbeing empowerment program.
Routinely collected police and hospital data are used to assess changes in alcohol-related hospital admissions, emergency department presentations, and crime. Community surveys are used to assess the experience of community members will alcohol related violence, injuries and safety. The cost-effectiveness analysis will adopt standardised methods that are international best-practice.
Activities have been successfully implemented over the past 12 months in all communities. Preliminary results from the community surveys showed that 12 months after implementing activities community members report feeling significantly safer, and that they have noticed less alcohol related physical abuse and injuries. Participants who attended the activities over a number of weeks also reported to be more satisfied with their lives and more empowered to make changes. Results from the routinely collected police and hospital data are pending.
Qualitative interviews with community members and other stakeholders showed that the project has been received very positively, with shop owners noticing that there are less young people hanging around their shop and trying to shoplift, teachers notice an improvements in their students attitudes and community members noticed a reduction in car thefts and break ins in their community. The key stakeholders reported on the importance of being equal partners – of being part of designing the solution not just being told about the problems and what they ought to do.
Peer reviewed publications
- Snijder, M., Shakeshaft, A., Wagemakers, A., Stephens, A. and Calabria, B. (2015). A systematic review of studies evaluating Australian indigenous community development projects: the extent of community participation, their methodological quality and their outcomes. BMC Public Health 15: 1154. DOI 10.1186/s12889-015-2514-7
- Shakeshaft, A., Snijder, M., Knight, A. (2016). Presentation at the 2016 NDARC Annual symposium.
- Shakeshaft, A., Snijder, M. , and Knight A. (2016). Invited presentation at the Peer Led Research Exchange organised by NSW Health and Sax Institute
- Snijder, M., Shakeshaft, A., Stone, C. and Calabria, B. (2016). The systematic development of community-based programs with Aboriginal people in three regional communities in Australia. Oral presentation at the 22nd IUHPE World Conference on Health Promotion, 22 – 26 May 2016, Curitiba, Brazil.
- Shakeshaft, A. (2015) Keynote address at the 2015 NSW Rural Health and Research Congress.
- Snijder, M., Shakeshaft, A., Stone, C. and Calabria, B. (2015). The systematic development of multi-component community-based interventions to reduce alcohol related harms among Aboriginal people in three rural towns in NSW. Oral presentation at 2015 NDARC Annual Symposium and 2015 Postgraduate Symposium
- Snijder, M., Shakeshaft, A., Wagemakers, A., Stephens, A. and Tsey, K. (2014). Community development to ‘close the gap’ between Indigenous and non-Indigenous Australians. Poster presented at the 2014 NDARC Annual Symposium and the AIATSIS National Indigenous Studies Conference 2014
- Snijder, M., Meredith, S., Shakeshaft, A. and Calabria, B. (2014). Community development and partnerships to close the gap between Indigenous and non-Indigenous Australians. Oral presentation at the National Indigenous Drug and Alcohol Council Conference 2014.
- December 2014: “Project targets alcohol related violence” – Narrandera Argus 2014. http://www.narranderaargus.com.au/ArticleDetails/tabid/65/ArticleID/1342/Project-targets-alcohol-related-violence.aspx
- January 2015: “Support sought for Midnight Basketball initiative in Griffith” – ABC 2015. http://www.abc.net.au/news/2015-01-15/midnight-basketball/6018180
- February 2015: “Project targets violence” – Narrandera Argus 2015. http://www.narranderaargus.com.au/ArticleDetails/tabid/65/ArticleID/1398/Project-targets-violence.aspx
- June 2015: “New Chapter for Grads” - Griffith Area News 2015, about Family Wellbeing facilitators. http://www.areanews.com.au/story/3128014/new-chapter-for-grads/
- August 2015: “Riverina research project aiming to reduce alcohol related violence in Aboriginal communities” – ABC News 2015. http://www.abc.net.au/news/2015-08-24/griffith-alcohol/6719070
- September 2015: “Midnight Basketball Returns to Griffith” – Griffith Area News http://www.areanews.com.au/story/3387420/midnight-basketball-returns-to-griffith/
- January 2016: “Inaugural Wiradjuri Cultural and Sports Festival a Success” – Griffith Area News http://www.areanews.com.au/story/3689867/skills-on-display-in-debut-carnival/
- April 2016: “Workshop to help at risk kids” - Narrandera Argus. http://www.narranderaargus.com.au/ArticleDetails/tabid/65/ArticleID/1880/Workshoptohelpatriskkids.aspx
- September 2016: “Survey reveals majority of Narrandera's Indigenous community "feel unsafe" at night” – Narrandera Argus http://narranderaargus.com.au/ArticleDetails/tabid/65/ArticleID/2057/Survey-reveals-majority-of-Narranderas-Indigenous-community-feel-unsafe-at-night.aspx
- October 2016: “Maldahnalanga project targets alcohol abuse in local area” – Griffith Area News http://www.areanews.com.au/story/4246316/this-drug-can-devastate/
Improved wellbeing of Aboriginal people in NSW; greater knowledge about effective approaches for reducing injury in Aboriginal populations.