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Table 2 Summary of included studies

From: Interventions to improve health literacy among Aboriginal and Torres Strait Islander Peoples: a systematic review

Source, Design, and Setting Aim/s Participants and Follow-up period Intervention Outcome Measures Results Conclusions Funding
Brimblecombe, et al. [41, 42]
Stepped-wedge RCT followed by Longitudinal sub-study
Extremely remote communities of Northern Territory
Examine the impact of a 20% price discount on fruit, vegetables, water, and artificially sweetened soft drink purchases +/− consumer education
Assess impact of the intervention on mediators, moderators and consequent dietary behaviour
20 communities where the community store was managed by the ALPA or OBS with no alternative food outlet present within a 20 km radius
Community populations of at least 100 persons (most approx. 200–400 persons) with estimated total population 8515 persons
Also assessed randomly selected adult ‘primary soppers’ from 5 communities via 3x questionnaire (on iPad) over 48-week period
-T1 baseline (n = 148)
-T2 immediately post intervention (n = 85)
-T3 24-weeks post intervention (n = 73)
− 92% female respondents
-Questionnaire completion incentivised with $20 gift of fruit, vegetables and water
All stores:
20% discount on all fresh and frozen fruit & vegetables (excluding potato products), bottled water and artificially sweetened soft drinks promoted in store and applied at point of sale
Discounts applied over 24-week period
0 stores:
10 stores (2 in each set) randomly assigned to receive consumer education (with at least 1 ALPA and 2 OBS in each set)
Consumer nutrition education delivered in-store using posters, activities, demonstrations and prizes
Delivered over 24-week period
Different themes each month
Use of Social Cognitive Theory
Weight of fruit and vegetables purchased per capita (in grams)
Weight of water and artificially sweetened soft drinks per capita (in grams)
Weight of less healthy foods, regular soft drinks and other beverages per capita (in grams)
Daily intake of fruit (g), vegetables (g), water (mL), regular soft drink (mL) and diet soft drink (mL)
Percieved affordability of fruit and vegetables
Self-efficacy to positively change intake, cook and try new foods
12.7% (95% CI, 4.1–22.1) increase in purchase of both fruit and vegetables
Largest change in fruit purchases 20.6% (95% CI, 6.8–36.2) as opposed to 9.0% for vegetables (1.2–17.4)
Consumer education further increased purchase of fruit and vegetables 7.6% (95%CI, 3.6–20.2) with greatest benefit seen in purchase of vegetables 13.6% (95% CI, 2.6–25.7)
Other food purchases also increased, including those of less-healthy foods 13.4% (95%CI, 1.7–26.4)
Perceived affordability of fruit and vegetables was associated with positive changes in dietary intake
Discounting fruits and vegetables by 20% to help protect against obesity and diet-related disease is partially effective
The effects of fiscal interventions can be enhanced by the use of creative merchandising techniques and consumer education
The intervention was partially effective in increasing consumption of fruits and vegetables among the target population, but was not strong enough to overcome mediators and moderators affecting lasting behaviour change
Canuto, et al. [43]
Pragmatic RCT
Urban South Australia (Adelaide)
Evaluate the effectiveness of intervention on reducing cardio-metabolic risk in population of interest
Assess whether outcomes maintained at 3 months post intervention
100 Indigenous women with waist circumference > 80 cm
Aged 18–64 years
Followed up over approx. 6 months with measurements taken at intervals:
- pre-intervention (T1)
- immediately post 12-week intervention (T2)
- 3 months post intervention (T3)
Poor participation at classes and workshops
12-week structured exercise and nutrition education program
The program comprised:
- bi-weekly 1-h group exercise classes (aerobic and resistance training by female instructor)
- incidental activity and walking measurement (pedometer and exercise diary)
- nutrition workshops (4 × 1 h by female dietician)
- positive reinforcement and encouragement (fortnightly newsletters)
Anthropometric and Biomedical Measurements:
-Body weight
-Hip and waist circumference
-Fasting glucose and insulin
-Lipid profile
Statistically significant reduction in weight and BMI in ‘active’ group relative to ‘waitlisted’ group at T3:
2.5 kg (95%CI, 4.46–0.54)
1.03 kg/m2
(95%CI, 1.79–0.27)
Other relative differences in measures noted however none were statistically significant
Modest reductions in weight, BMI and BP evident at T2 with further improvement by T3
No change in primary outcome measures (waist circumference and metabolic measures)
Ju, et al. [44]
Port Augusta, Regional South Australia
Determine the effect of an oral health literacy intervention on oral health-literacy related outcomes among rural-dwelling Indigenous Australian adults 400 Indigenous adults residing in Port Augusta or surrounds
Case group mostly female, low levels of education, receiving welfare and regular consumers of tobacco and alcohol
Randomised into:
-Group A Intervention (n = 203)
-Group B Control (n = 197)
Incentive-based participation - gift vouchers were used to compensate participants for their time
Overall attendance at workshops just 46.8% (95 participants)
Five 1.5-h workshops over 12 months conducted by Indigenous staff
Workshops comprised of presentations, hands-on activities, interactive displays, group discussion and role playing
Developed with two Indigenous research officers
Use of Bandura’s Social Cognitive Theory
Incentive-based intervention model
Self-report questionnaires at baseline and 12 months
Some improvement of reported related to:
-Self- Efficacy
-Behaviour Change
Outcome measures used include HeLD-14, OHIP-14, Lachman and Weaver and Finlayson scales
Improvement of oral health literacy (mean change 1.3, 95% CI) – difference statistically significant
Creating awareness of the social impacts of poor oral healt
Increasing sense of personal control and oral health self-efficacy
Statistically significant improvement in participants who reported ‘water with fluoride is good’ (RR 1.2, 95%CI, 1.1–1.3)
The intervention was found to be partially successful in improving oral health literacy and oral health literacy-related outcomes only after multiple implementations
The intervention is considered by the authors to not be feasible in practice, due to poor attendance and expense.
Mills et al. [45]
Pre-Post Quasi
Urban areas of South East Queensland
Improve health outcomes of individuals with or at risk of cardiovascular disease
Improve self-management
Assess effectiveness of intervention on clinical outcome measures
Inclusion of 85 participants
Referral by general practitioner
Inclusion criteria:
-Presence of at least one cardiovascular disease, or
-Presence of at least one cardiovascular disease risk factor
Age 18–74+ years
12-week follow up period
45-min ‘yarning’ (education) sessions followed by 1-h exercise sessions (both with qualified health professionals and Indigenous staff in attendance) Changes in clinical outcome measures:
-Waist & hip circumferences
-Results of 6-min walk test
Statistically significant results included:
-Reduction in the weight of extremely obese participants (1.6 kg, 0.1–3.0 kg, 95% CI)
-Improved distance able to be walked in six minutes (0.053 km, 0.01–0.07 km, 95% CI)
-Decreased BP in participants who were hypertensive at baseline (11 mmHg, 3.2–18.8 mmHg, 95%CI)
This short-term study may indicate a possibility for increased improvements in clinical outcomes as the result of behaviour change over longer time periods
This program could provide a useful model for similar future interventions among Aboriginal and TSI populations
National Heart Foundation Australian Indigenous Scholarship
Pettigrew, et al. [46]
Pre-Post Longitudinal Survey
Both metropolitan and regional areas throughout Western Australia
Assess the relative effectiveness of an adult nutrition education program for both Indigenous and non-Indigenous participants
Evaluate whether the program requires modification to achieve the same knowledge and behaviour changes in the Indigenous group as the non-Indigenous group
Total sample of 875 Western Australians:
− 706 non-Indigenous
− 169 Indigenous
Pre-post questionnaires followed up over 2- year evaluation period
Two course types were offered to participants:
-Single-session course of 1–2 h covering a limited number of nutrition topics
-Multi-session courses ranging from 2 to 8 sessions providing information on a broader range of nutrition topics
Participants free to choose which best suited their needs
Confidence in ability to buy healthy foods on a budget
Knowledge about risk factors and disease
Informed food choices and better nutrition
Motivation and behaviour change
Improvements in outcome measures greater among Indigenous participants in all instances
Improvement in confidence of ability to buy healthy foods on a budget between participants:
(M = 0.74, SD = 1.17, n = 156)
(M = 0.53, SD = 1.05, n = 676)
The program demonstrated superior outcomes amongst Indigenous participants when compared to non-Indigenous participants on many key outcomes
Potential to achieve positive results with broader population while also addressing health inequities for Indigenous population
Western Australian Department of Health
  1. ALPA Arnhem Land Progress Aboriginal Corporation, BMI Body Mass Index, BP Blood Pressure, CI Confidence Interval, CRP C-Reactive Protein, HbA1C Glycated Haemoglobin, HeLD Health Literacy in Dentistry Scale, M Mean, NHMRC National Health and Medical Research Council, OBS Out Back Stores, OHIP-14 Oral Health Impact Profile, SD Standard Deviation, TSI Torres Strait Islander people