Medicine and Health Sciences Commons^™

Use Of A Primary Care Dataset To Describe ‘The Real Picture’ Of Diabetes In Kimberley Aboriginal Communities, Caitlyn S. White, Kimberley Seear, Lorraine Anderson, Emma Griffiths

Journal of the Australian Indigenous HealthInfoNet

Objective
Aboriginal communities are impacted by high rates of diabetes, however these are currently underestimated by national data sources used by policy and decision makers to inform allocation of health resources. We aimed to estimate diabetes prevalence and screening coverage using primary care electronic medical record data.

Methods
A cross-sectional audit was conducted using primary care data from Aboriginal regular Aboriginal Community Controlled Health Service (ACCHS) clinic attendees aged 15 years and over (n=1763) in five remote communities in the Kimberley region. Main outcome measures were overall diabetes prevalence; age-specific diabetes prevalence; prevalence of pre-diabetes; and screening rates among patients …

The Inequitable Burden Of Infectious Diseases Among Remote-Living Aboriginal And Torres Strait Islander Australians: A Product Of History, Stephanie L. Enkel, Rebecca Famlonga, Hannah M. M. Thomas, Nina Lansbury, Jonathan R. Carapetis, Glenn Pearson, Asha C. Bowen

Journal of the Australian Indigenous HealthInfoNet

Insufficient and poorly maintained housing and plumbing in many remote Australian Indigenous communities in Australia results in reduced capacity to maintain personal hygiene, contributing to infectious disease inequalities. Infections from Streptococcus pyogenes (Strep A) and sequalae are often noted to be the result of contextual poverty; a product of over 230 years of discriminatory practice that has excluded Indigenous people from the basic human rights of healthy, maintained housing afforded to most in the nation. The solutions for eliminating diseases of inequity among Australian Indigenous population are known, their success is historically documented, and yet they are to be comprehensively …

The Koolungar Moorditj Healthy Skin Project: Elder And Community Led Resources Strengthen Aboriginal Voice For Skin Health, Bernadette M. Ricciardo, Jacinta Walton, Noel Nannup, Dale Tilbrook, Heather-Lynn Kessaris, Carol Michie, Brad Farrant, Roni Forrest, Annette Garlett, Joanne Hill, Larissa Jones, Natasha Kickett, Sally Smith, Delys Walton, Taleah Ugle, Nadia Rind, Richelle Douglas, Jodie Ingrey, Brenda Carter, Ainslie Poore, Ingrid Amgarth-Duff, Hannah Thomas, Prasad S. Kumarasinghe, Jonathan R. Carapetis, Asha C. Bowen

Journal of the Australian Indigenous HealthInfoNet

In partnership with local Aboriginal Community Controlled Health Organisations, the Elder-led co-designed Koolungar Moorditj Healthy Skin project is guided by principles of reciprocity, capacity building, respect, and community involvement. Through this work, the team of Elders, community members, clinicians and research staff have gained insight into the skin health needs of urban-living Aboriginal koolungar (children); and having identified a lack of targeted and culturally appropriate health literacy and health promotion resources on moorditj (strong) skin, prioritised development of community-created healthy skin resources. Community members self-appointed to Aboriginal Community Advisory Groups (CAG) on Whadjuk (Perth) …

The Health Outcomes And Health Service Needs Of The Martu And Nyiyaparli People Of Northwest Western Australia: A Grey Literature Review, Keith Mcnaught, Colette Rhoding, Michelle J. Schwager

Journal of the Australian Indigenous HealthInfoNet

Introduction: Health outcomes for Australian Aboriginal and Torres Strait peoples are very poor. This is considerably worse in remote regions. The East Pilbara, where the Aboriginal and Torres Strait Islander communities of the Martu and Nyiyaparli people reside, is one such remote region.

Methods: This review explored the grey literature relating to the health services and health outcomes of the Martu and Nyiyaparli people. Search strategies included specific search terms as well as the systematic search of specific websites likely to inform this review. To ensure relevance of the data, the review incorporated documents published in the last five years …

The Parenting Education Needs Of Aboriginal Women Experiencing Incarceration, Belinda J. Lovell, Mary Steen, Angela Brown, Karen Glover, Adrian Esterman

Journal of the Australian Indigenous HealthInfoNet

The aim of this study was to listen to the voices of women experiencing incarceration and understand their parenting education needs. This paper reports on data from focus group interviews with 13 Aboriginal women in prison. The data were analysed using reflexive thematic analysis, creating five themes: (1) working towards a positive self; (2) communication (3) parenting from a distance; (4) jumping through hoops to get connected; and (5) connecting with Aboriginal cultures. The women were seeking guidance and clarity about the Child Protection system and how to regain child custody. Many women were wanting to invest in self-care and …

Review Of Gynaecological Cancer Among Aboriginal And/Or Torres Strait Islander People In Australia, Aime Powell, Ami Morseu-Diop, Maya Morton Ninomiya, Uday Narayan Yadav, Emily Phillips, Devendra Raj Singh, Tamara Butler, Emma Allanson, Lisa J. Whop

Journal of the Australian Indigenous HealthInfoNet

Gynaecological cancers bear a significant burden on the health of Australians. Whilst Australia has made great strides in reducing the overall gynaecological cancer burden nationally, Aboriginal and/or Torres Strait Islander women continue to experience disproportionately high rates of gynaecological cancers.

This review focuses on the social, cultural, and historical contexts that contribute to inequitable gynaecological cancer rates among Aboriginal and/or Torres Strait Islander women. An in-depth discussion on cervical cancer, ovarian cancer, and uterine cancer are described; including the incidence, mortality, survival, and management of these diseases for Aboriginal and/or Torres Strait Islander women.

It highlights both the persistent barriers …

Exploring The Experiences Of The Consent Process For Aboriginal And Torres Strait Islander People Having Cardiac Surgery And Participating In Medical Research: A Study Protocol, Julieann Coombes, Keziah Bennett-Brook, Kate Hunter, Tamara Mackean, Edward Litton, Jacquita S. Affandi, Courtney Ryder, Bobby Porykali, Brea Grant, Kenneth Yakubu, Colin Garlett, Camila A. Kairuz Santos

Journal of the Australian Indigenous HealthInfoNet

Background: Gaining informed consent is a critical step before any medical procedure, and before taking part in medical research. Cultural differences in concepts of health and healing, communication, language, and racism, can play a part in forming barriers to gaining informed consent for Aboriginal and Torres Strait Islander people. For Aboriginal and Torres Strait Islander people, a lack of informed consent can worsen distrust and contribute to continuing health disparities. This protocol describes a study aimed at providing a better understanding of informed consent experiences of Aboriginal and Torres Strait Islander people undergoing heart surgery and participating in research. This …

Brief Report: Out Of Sight Out Of Mind - Preventable Childhood Kidney Disease In The Far North, Johanna Neville, Allison Hempenstall, Caroline Taunton, Valmay Fisher, Malcolm Mcdonald

Journal of the Australian Indigenous HealthInfoNet

APSGN is an immune-mediated kidney disease that occurs after a Streptococcus pyogenes skin or throat infection in children and contributes to chronic kidney disease later in life. It is a disease of poverty and regrettably common in Aboriginal and Torres Strait Islander children. There have been seven documented APSGN outbreaks across Far North Queensland in the last nine years. Despite this disease being notifiable in both Western Australia and the Northern Territory, Queensland is yet to acknowledge the importance of early notification in the management of APSGN. Notification-driven publication of APSGN incidence should help raise its profile and stimulate better …

What Works For Aboriginal And Torres Strait Islander Men? A Systematic Review Of The Literature, Jack R. Menges, Marie L. Caltabiano, Alan Clough

Journal of the Australian Indigenous HealthInfoNet

Aboriginal and Torres Strait Islander men experience significantly higher rates of suicide, trauma, alcohol related deaths and unemployment than other Australian men. Despite significant levels of government intervention, rates of family violence, unemployment and incarceration continue to increase in Aboriginal and Torres Strait Islander communities. As a subset of the Aboriginal and Torres Strait Islander population, there has been a lesser focus on how to meaningfully improve the wellbeing of Aboriginal and Torres Strait Islander men. This systematic review seeks to understand what interventions, programs and activities are successful in improving the wellbeing of Aboriginal and Torres Strait Islander men …

Review Of Alcohol And Drug Treatment For Aboriginal And Torres Strait Islander Peoples, Marguerite Tracy, Bradley Freeburn, Kylie Lee, Julie Woods, Kate Conigrave

Journal of the Australian Indigenous HealthInfoNet

This review provides an overview of treatments for problem alcohol and other drug (AOD) use for Aboriginal and Torres Strait Islander people. It includes information on the available research and discusses core principles for providing treatment. The review outlines how effective mainstream treatment approaches can be adapted to be more suitable for Aboriginal and Torres Strait Islander ways of being or worldview. It also highlights that services, such as those offered by Aboriginal community controlled health organisations are in a unique position to offer culturally secure treatment approaches. The barriers to accessing treatment are discussed as well as recommendations for …

Impact Evaluation Of A Central Australian Aboriginal Cultural Awareness Training Program For Health Professionals And Students, Chris Rissel, Lynette Liddle, Courtney Ryder, Annabelle Wilson, Madeleine Bower, Barbara Richards

Journal of the Australian Indigenous HealthInfoNet

The aim of this study was to prospectively evaluate the impact of a Central Australian cultural awareness training program for health care staff. A mixed methods approach was used. Program participants completed a baseline and post-program questionnaire, which included an attitude scale assessing cultural safety, critical thinking and transformative unlearning, and open-ended questions. An online follow-up survey two months later repeated these questions. Mean scale scores were compared using paired and unpaired t-tests. Qualitative data were analysed thematically. Baseline scale mean was 45.7. At post-program it had statistically significantly increased to 47.3, using both the paired (p=< 0.01) and unpaired t-test (p=< 0.03). At the two-month follow-up it had decreased to 42.2. This was not statistically different from the baseline score with a paired (n=11) t-test (p=< 0.37), however the difference was statistically significant with an unpaired t-test (p=< 0.01) which included an additional eight respondents. Qualitative feedback was consistently positive. Many respondents learnt new information about the negative effects of colonisation on Aboriginal and/or Torres Strait Islander people, and how this continues to affect current health. Learning about Aboriginal and/or Torres Strait Islander cultures, kinship relationships and systems, and communication styles was identified as directly relevant to work practices. A cultural education program produced positive short-term changes in attitudes and was highly valued by participants. However, it is unclear if these changes are maintained in the medium term.

Assessing The Validity Of A Culturally Modified Drinking Motives Questionnaire For Use In Aboriginal Communities, David Tucker, Martyn Symons, Elaine Clifton, Margaret Ramirez, James P. Fitzpatrick, Roz Walker, Glenn Pearson, Michelle Gray, Gary Kirby, Nyanda Mcbride

Journal of the Australian Indigenous HealthInfoNet

Alcohol related harms disproportionately affect Aboriginal people in Australia. Motives to drink have been identified as the most proximal factor to alcohol consumption.The aim of this study is to assess the validity of a culturally modified Drinking Motives Questionnaire-Revised (DMQ-R) (Cooper, 1994) with Aboriginal participants. The study was cross sectional, utilising data collected via face-to-face surveys with a sample of adult Aboriginal participants. A convenience sample of 135 Aboriginal men (n=41) and women (n=94) from the Pilbara Region of Western Australia, who had consumed alcohol in the preceding 12 months. The Culturally modified DMQ-R (CDMQ-R) developed in consultation with Aboriginal …

First-Stage Development Of The Pitjantjatjara Translation Of The World Health Organization’S Alcohol, Smoking And Substance Involvement Screening Test (Assist), Matthew Wr Stevens, Dom Barry, Sue Bertossa, Mark Thompson, Robert Ali

Journal of the Australian Indigenous HealthInfoNet

Substance use is a leading contributor to global disease, illness and death. Compared with non-Indigenous Australians, Aboriginal and Torres Strait Islander Australians are at an increased risk of substance-related harms due to the experience of additional social, cultural, and economic factors. While preventive approaches, including screening and early interventions are promising, currently there are limited options available to healthcare workers that are culturally appropriate for use in Aboriginal and Torres Strait Islander populations. Therefore, the aim of this research was to translate and culturally adapt the World Health Organization endorsed, Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) into Pitjantjatjara. …

Review Of Cannabis Use Among Aboriginal And Torres Strait Islander People, Julia Butt, Mandy Wilson, Jocelyn Jones, Simon Lenton

Journal of the Australian Indigenous HealthInfoNet

The health effects of cannabis use may not always be seen as a high priority for Aboriginal and Torres Strait Islander communities. However, the impact of cannabis use on physical and mental health can have significant consequences. It is known that the use of high potency cannabis has increased over the last two decades, with a corresponding increased risk to health. In particular, young people are at increased risk of experiencing harms to mental health. Physical harms to health include effects on the respiratory system, cardiovascular system, an increased risk of cancer, and in-utero effects from maternal use. The review …

Review Of Diabetes Among Aboriginal And Torres Strait Islander People, Katherine Ride, Samantha Burrow

Journal of the Australian Indigenous HealthInfoNet

Diabetes is the fastest growing chronic disease condition globally. Type 2 diabetes in particular, has reached epidemic proportions, with the greatest burden falling on socially disadvantaged groups and Indigenous peoples.

This review focuses primarily on type 2 diabetes among Aboriginal and Torres Strait Islander people, which is responsible for the majority of cases of diabetes in this population. It provides general information on the social and cultural context of diabetes, and the behavioural and biomedical factors that contribute to diabetes among Aboriginal and Torres Strait Islander people.

This review provides detailed information on:

• the extent of diabetes among Aboriginal and …

Culturally Safe And Integrated Primary Health Care: A Case Study Of Yerin Eleanor Duncan Aboriginal Health Services’ Holistic Model, Julieann Coombes, Patricia Cullen, Keziah Bennett-Brook, Marlene Longbottom, Tamara Mackean, Belinda Field, Vickie Parry

Journal of the Australian Indigenous HealthInfoNet

Objective

To understand the importance of culturally safe integrated primary health care for Aboriginal families in the Central Coast of New South Wales, where their social and emotional wellbeing is impacted through a range of health issues related to domestic and family violence.

Methods
An Indigenous methodology of yarning through conversational semi-structured interviews with seven primary health care workers at Yerin, an Aboriginal Community Controlled Health Service (ACCHS) in New South Wales. Yarning sessions explored factors that enable and/or inhibit the provision of holistic and comprehensive trauma and culturally informed responses to Aboriginal and Torres Strait Islander women who experience …

Evaluating Patient Experience At A Novel Health Service For Aboriginal And Torres Strait Islander Prisoners: A Pilot Study, Lachlan Arthur, Ana Herceg, Heidi Shukralla, Jason Payne, Julie Tongs Oam

Journal of the Australian Indigenous HealthInfoNet

Background
The Winnunga Alexander Maconochie Centre Health and Wellbeing Service (AMCHWS) is the first prison health service operated by an Aboriginal Community Controlled Health Organisation in Australia. This pilot study developed and implemented a patient experience survey to evaluate the novel model of healthcare delivered by the Winnunga AMCHWS to Aboriginal and Torres Strait Islander prisoners.

Methods
Patients accessing the Winnunga AMCHWS between February and May 2020 were invited to participate in the study. Descriptive data were analysed and compiled for demographics, patient satisfaction, patient perception of care quality, cultural safety, and patient thoughts on the Winnunga AMCHWS.

Findings
Sixteen …

Protocols For An Aboriginal-Led, Multi-Methods Study Of The Role Of Aboriginal And Torres Strait Islander Health Workers, Practitioners And Liaison Officers In Quality Acute Health Care, Annabelle Wilson, Tamara Mackean, Liz Withall, Eileen M. Willis, Odette Pearson, Colleen Hayes, Kim O'Donnell, Janet Kelly, Kerry Taylor, Judith Dwyer, Elizabeth Bourke, Kate Hunter, Lorna Murakami-Gold, Rebecca Ivers, Fran Baum

Journal of the Australian Indigenous HealthInfoNet

Objectives
Aboriginal and Torres Strait Islander Health Workers/Practitioners and Liaison Officers play an important, often critical role providing advocacy and cultural and emotional support for Aboriginal and Torres Strait Islander patients. The main goals of this research are to explore i) how Aboriginal and Torres Strait Islander Health Workers/Practitioners and Liaison Officers are integrated in the routine delivery of care for Aboriginal and Torres Strait Islander peoples in hospital, and ii) how the role of Aboriginal and Torres Strait Islander Health Workers/Practitioners and Liaison Officers facilitates quality health outcomes.

Methods
This study is being conducted in three different hospitals using …

Australian Teachers’ Perceptions And Experiences Of Food And Nutrition Education In Primary Schools: A Qualitative Study, Gozde Aydin, Claire Margerison, Anthony Worsley, Alison Booth

Australian Journal of Teacher Education

Teacher delivered food and nutrition education (FNE) can be effective in improving children’s food literacy and eating habits. However, teachers are known to face some barriers to the delivery of FNE globally. To obtain a deeper understanding of Australian primary school teachers’ experiences and views, 17 teachers were interviewed. The results of the thematic analysis showed that teachers acknowledged the importance of FNE and were willing to include more FNE content into their teaching. We also identified the FNE topics taught, resources used, their teaching partners, and barriers encountered. The discussion presents strategies to overcome these barriers.

Aboriginal Health Consumers Experiences Of An Aboriginal Health Curriculum Framework, Petah Atkinson, Marilyn Baird, Karen Adams

Australian Indigenous HealthBulletin

Introduction

In settler colonised countries medical education is situated in colonist informed health systems. This form of colonisation is characterised by overt racism and contributes to the significant health inequities experienced by Indigenous peoples. Not surprisingly, medical accreditation bodies in these countries have mandated the curriculum include content relating to Indigenous peoples. However, what is absent is the Indigenous health consumer worldview of health care and their nuanced lived experience of the delivery of medical care.

Methods

Yarning methods, integral to Aboriginal peoples’ ways of understanding and learning, were utilised. A Yarning guide was constructed with Social Yarn and Research …

The Development And Implementation Of A Culturally Safe Survey For Measuring Knowledge, Attitudes And Values Around Fasd And Alcohol Use During Pregnancy In A Remote Australian Aboriginal Community Setting, Martyn Symons, David Tucker, Kaashifah Bruce, Annalee Stearne, Annette Kogolo, Maureen Carter, June Oscar, Glenn Pearson, James P. Fitzpatrick

Australian Indigenous HealthBulletin

Fetal Alcohol Spectrum Disorder (FASD) describes a lifelong neurodevelopmental disability caused by prenatal alcohol exposure that has a devastating impact on individuals, families and communities. The prevalence of FASD is high in some Indigenous communities around the World and the only active case ascertainment prevalence study conducted in Australia found a rate of 19.44 per 100 children in the remote Fitzroy Valley region of Western Australia. Following this study community led FASD prevention activities were implemented under the Marulu (“Worth Nurturing”) Strategy in the Fitzroy Valley.

A Knowledge, Attitudes and Practices survey was designed to assess the impact of the …

Review Of Sexual Health Issues Linked With Cardiovascular Disease And Type 2 Diabetes Mellitus In Aboriginal And Torres Strait Islander Males, Veronica Collins, Tamara J. Swann, Jane Burns, Tim Moss, Mick Adams

Australian Indigenous HealthBulletin

There are well established links between male sexual health conditions and chronic disease, particularly cardiovascular disease (CVD) and type 2 diabetes (T2DM). Erectile dysfunction (ED) and low testosterone are two sexual health conditions that are relatively common among the wider male population. However, there is a lack of data specifically about these sexual problems among Aboriginal and Torres Strait Islander males.

One of the most important findings of research regarding the links between sexual health and chronic disease is that ED can be a risk marker for future CVD or undiagnosed T2DM. Understanding these links can lead to more holistic …

Review Of Fetal Alcohol Spectrum Disorder (Fasd) Among Aboriginal And Torres Strait Islander People, Sharynne Hamilton, Michael Doyle, Carol Bower

Australian Indigenous HealthBulletin

Fetal Alcohol Spectrum Disorder (FASD) is a preventable, lifelong disability that disproportionately affects Aboriginal and Torres Strait Islander people. This review provides a comprehensive synthesis of the available information on FASD among Aboriginal and Torres Strait Islander people, with reference to the limitations on population-based data and evaluated programs. The review outlines; the harms of alcohol use in the context of colonisation, cultural perspectives on assessment and diagnosis, effective prevention programs and a summary of state and national policies. Health impacts, educational outcomes and the effects of FASD on vulnerable populations such as children in protection and young people in …

Targeted Teacher Education To Improve Primary Preservice Teachers’ Knowledge And Understanding Of Uv And Effective Sun Protection Measures For Children, Joseph J. Scott, Robyn S. Johnston, Natasha Bear, Sonia Gregory, Sally Blane, Mark Strickland, Jill Darby, Elin S. Gray

Australian Journal of Teacher Education

Teachers are responsible for children at school during peak ultraviolet (UV) times of the day. It is paramount that teachers have knowledge and understanding of UV to effectively protect themselves and their students. The aim of this pilot study was to investigate the effect of a short intervention on preservice teachers’ sun protective behaviours, knowledge and perceived skill to teach sun safety. Participants (n =161; median age=20 years) attended a 45-minute preservice teacher sun safety intervention and completed pre- and post-test surveys. Post-intervention, most participants indicated they felt: i) more informed about the dangers of UV and risks of developing …

An Exploration Of Interventions For Healing Intergeneration Trauma To Develop Successful Healing Programs For Aboriginal Australians: A Literature Review, Alison J. Simpson, William Abur, James A. Charles

Australian Indigenous HealthBulletin

Introduction

Health outcomes and life expectancy of Indigenous people throughout the world are far poorer than non-Indigenous populations. Emerging evidence from research shows that many social issues which impact on Indigenous peoples globally is linked to trauma over generations. This review explores literature about Indigenous people from around the world to seek interventions which have been successful in healing intergenerational trauma.

Method

To identify interventions that have been successful in healing intergenerational trauma amongst Indigenous populations globally, a systematic search strategy was conducted using keywords and synonyms related to the topic. Peer reviewed academic literature was sourced from four …

School-Based Youth Physical Activity Promotion: Thoughts And Beliefs Of Pre-Service Physical Education Teachers, Jerome N. Rachele, Thomas F. Cuddihy, Tracy L. Washington, Steven M. Mcphail

Australian Journal of Teacher Education

Physical education teachers are central to the facilitation of school-based physical activity promotion. However, teachers have self-reported a lack of knowledge, skills, understanding, and competence to successfully implement these strategies. The aim of this investigation was to explore the beliefs and perceptions of pre-service physical education teachers, concerning their potential roles in future school-based programs designed to promote student physical activity. Fifty-seven pre-service physical education teachers (21 males and 36 females) had complete data and were included in the analysis. Participants responded positively, and did not reveal concerns about their capacity to facilitate school-based physical activity promotion during practicum, and …

Should Educators Be ‘Wrapping School Playgrounds In Cotton Wool’ To Encourage Physical Activity? Exploring Primary And Secondary Students’ Voices From The School Playground, Brendon P. Hyndman, Amanda Telford

Australian Journal of Teacher Education

Physical activity in school playgrounds has changed considerably over recent decades to reflect a climate of ‘surplus safety’. A growing culture of surplus safety can be attributed to a desire of parents and teachers responsible for children to protect school students from danger. The aim of this research was to examine students’ perceptions of playground safety influences on physical activity during school breaks from the perspectives of the ‘users’ of school playgrounds. Data collection consisted of seven focus groups (4 primary school & 3 secondary school) conducted across four schools (2 primary & 2 secondary). During this study, the focus …

Averting Uncertainty: A Practical Guide To Physical Activity Research In Australian Schools, Jerome N. Rachele, Thomas F. Cuddihy, Tracy L. Washington, Steven M. Mcphail

Australian Journal of Teacher Education

Preventative health has become central to contemporary health care, identifying youth physical activity as a key factor in determining health and functioning. Schools offer a unique research setting due to distinctive methodological circumstances. However, school-based researchers face several obstacles in their endeavour to complete successful research investigations; often confronted with complex research designs and methodological procedures that are not easily amenable to school contexts. The purpose of this paper is to provide a practical guide for teachers (both teacher educators and teaching practitioners) seeking to conduct physical activity-based research in Australian school settings, as well as discuss research practices. The …

Moving Physical Activity Beyond The School Classroom: A Social-Ecological Insight For Teachers Of The Facilitators And Barriers To Students' Non-Curricular Physical Activity, Brendon Hyndman, Amanda Telford, Caroline F. Finch, Amanda C. Benson

Australian Journal of Teacher Education

Non-curricular avenues such as active play during school breaks have been established as a major source for children’s physical and cognitive development, yet there is little information for teachers on the influences affecting primary and secondary school students’ non-curricular physical activity. During this study focus groups and drawing were used to explore the broader influences on primary (n=47) and secondary (n=29) school students’ physical activity behaviour beyond the classroom. Barriers and facilitators to children’s physical activity were categorised using a multi-level social-ecological framework incorporating intrapersonal, interpersonal, physical environment and policy factors. Based on the drawings, comparisons between students’ existing play …