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Objectives: To examine the experiences of Aboriginal Australians with or at risk of diabetes who attended urban community cooking courses in 2002-2007; and to develop recommendations for increasing the uptake and effectiveness of nutrition education in Aboriginal communities. Methods: Descriptive qualitative approach using semistructured interviews with 23 Aboriginal course participants aged 19-72. Verbatim transcripts were coded using NVivo 7 software, and qualitative analysis was undertaken. Results: Engagement and learning were increased by emphasizing the social aspects of the program, holding the course in a familiar Aboriginal community-controlled health setting and using small group learning with Aboriginal peers. Partnership with a vocational training institute provided teaching expertise, but there was conflict between vocational and health promotion objectives. Conclusions and Implications: Nutrition programs for Aboriginal Australians should be social, flexible, and held in accessible, culturally appropriate settings and focus on healthful cooking techniques using simple, affordable ingredients.

Background: Good primary care for people with substance use disorders (SUDs) is crucial given the high prevalence of SUDs and overdose deaths.Objective: To explore general practice care for people with a history of SUDs from the perspectives of women involved with the criminal justice system.Methods: Qualitative interview study with pre- and postrelease interviews, undertaken in Australian prisons and community settings. We utilized thematic analysis informed by constructivist grounded theory.Results: We undertook 65 interviews with 39 women. Access to and experience of general practitioner (GP) care was affected by perceived welcomeness, decisions around disclosure, and consultation experiences related to medication prescription. Participants reported that they were not as welcome as other patients, welcome could be conditional on not disclosing SUDs or only requesting unrelated healthcare, and GPs did not always differentiate between past and current drug use. Participants perceived difficulty finding general practices where the potential benefit of disclosing SUDs outweighed the risks of stigmatized reactions and lack of GP skills and interest. Participants did not always recognize that care beyond physical health could occur in general practice. The pejorative implications of labelling patients as "doctor shoppers" were challenged by participants, as they considered it could be necessary to attend multiple GPs to find a welcoming practice.Conclusions: People with histories of SUDs do not uniformly experience welcomeness in general practice, perpetuating poor engagement in healthcare and poor outcomes related to SUDs. Programmes targeting prescription drug misuse through general practice should also promote welcomeness for people with SUDs. [ABSTRACT FROM AUTHOR]

Objective: Aboriginal and Torres Strait Islander people experience adverse health outcomes and have high rates of smoking and related illnesses. This brief report describes stress as a barrier to quitting smoking derived from reflections within an Aboriginal Medical Service and makes recommendations for intervention development. Methods: A high-intensity smoking cessation program was conducted within a suburban Aboriginal Medical Service in Western Sydney, Australia, over a 10-month period. The intervention included weekly cessation counselling sessions and dispensation of free nicotine replacement therapy (NRT). Results: During the observation period, 32 clients made quit attempts. To date, three clients (9%) have quit smoking. Chronic and intercurrent life stressors were noted to be the main barriers to smoking cessation described by participants. Conclusions: Achieving smoking cessation among Indigenous people is made significantly more complex because of multiple life stressors experienced. Implications: Future interventions targeting Indigenous Australians should take greater account of stressful life events and their impact on quitting smoking. Key words: Smoking cessation, Indigenous health services, life change events, psychological stress.

Over 60% of Canadian women with breast cancer use complementary and alternative medicine (CAM). The popularity of CAM has led to a body of inquiry into the reasons why cancer patients use CAM. While knowledge of the predictors of CAM use has been helpful in identifying patients most likely to use CAM, the development of decisional models is needed to illustrate the complexity of decisions specific to CAM. The purpose of this study was to understand the processes through which women with breast cancer make decisions about CAM. The goal is to provide a foundation for the development of information and decisional resources that support cancer patients in making informed choices about CAM. Using grounded theory methodology, this study involved 21 women living with early-stage breast cancer who were identified as being consumers of CAM. In-depth, open-ended interviews were conducted and transcribed verbatim. Thematic and open coding was initially conducted, followed by a constant comparison of the data Three distinct styles of CAM decision-making exist among women with breast cancer. For some women, a "stepwise" decision-making model occurred, in which CAM decisions shifted as they moved through the conventional treatment trajectory. Other women expressed a "parallel" decision-making style that had conventional and CAM treatment decisions being made concurrently but independently from one another and with minimal conflict. In the "integrative" decision-making style, women perceived conventional cancer treatments and CAM to be part of a continuum of care and made treatment decisions in an integrated manner. The results of this study have important clinical implications, including better prediction of CAM utilization across the breast cancer experience, improved provider- patient communication about CAM, and the development of appropriate educational and decisional support services, such as decision aids. Funding Sources: Canadian Institutes of Health Research and Canadian Breast Cancer Research Alliance [ABSTRACT FROM AUTHOR]

Aboriginal people have a higher burden of cardiovascular risk factors and heart disease and poorer outcomes after heart attacks when compared with other Australians. Indigenous status is also a risk factor for delayed response to heart attack symptoms. A community DVD about preventing and managing heart disease was made at the Aboriginal Medical Service Western Sydney in 2005. The aim of this article is to reflect on the process of making the DVD as a community driven health promotion activity and to explore questions raised and insights gained about heart health education for Aboriginal people in the context of the existing literature. The importance of education about heart attack symptom recognition and prompt hospital presentation, as well as risk factor management, by general practitioners and other health practitioners working with Aboriginal people, is highlighted.