Population, Health Behaviour and the Underlying Reasons
The population selected for this task is indigenous Australian teenagers and the health behaviour being studied is the use of illicit substances. This population cohort is affected by illicit substance use disproportionately when compared to their non-indigenous counterparts. According to the Australian Institute of Health and Welfare (AIHW) (2018), in 2016, 27 per cent of aboriginal Australians used illicit drugs, which was almost two times higher than the 15.3 per cent associated with non-indigenous Australians. The commonly used illicit drugs include marijuana (16.7 per cent) and non-medical use of pharmaceutical drugs (11 per cent) (Graham & Clough 2018). Therefore, it is important to understand the underlying reasons that cause this population to use illicit substances.
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The reasons behind the widespread use of illicit substances among aboriginal Australians are many and complex. However, the common risk and causative factors of this behaviour include homelessness, effects of colonisation, dispossession, unemployment, poor living standards and departing from culturally meaningful practices. Other factors include boredom, family conflict, dependence on welfare and the lack of appropriate amenities and facilities. According to Vey (2018), there is a strong correlation between poverty and drug abuse, and this observation could be used to explain the disproportionate use of illicit substances among Aboriginal Australians. The majority of Aboriginal Australians are exposed to at least one of these predisposing factors, which makes them prone to the use of illicit substances. This assertion underscores why the majority of people in this population cohort are vulnerable to such kind of behaviour.
However, despite the extensive use of illicit substances, some protective factors exist within communities of Aboriginal s in Australia. For instance, cultural support and growth play an important role in ensuring that people do not spend their time abusing drugs. Education is also a central protective factor as the number of Aboriginals’ children joining and remaining in school has been increasing over the last years (Baxter & Meyers 2019). After being educated, Aboriginals stand a good chance to secure employment opportunities, which alleviates poverty levels and curtails the probability of drug abuse based on the risk factors identified above.
The behaviour of widespread use of illicit substances among indigenous Australians could be explained using the minority stress theory. Based on the context of this theory, victimisation, experienced or perceived discrimination and internalised stigma place the affected individuals at the risk of negative health outcomes, such as substance use and abuse (Goldbach et al. 2014). As mentioned earlier, Aboriginal Australians have been subjected to colonisation and dispossession leading to internalised stigma and lack of social mobility opportunities, hence poverty. This scenario leads back to the list of risk factors associated with the use of illicit drugs among Aboriginals. As such, the minority stress theory explains the widespread behaviour of drug abuse within the said population.
Some of the ethical dilemmas faced when researching on substance abuse among Aboriginals include decision-making capacity and informed consent from the participants. The age of the participants (teenage Aboriginal Australians) may be another ethical concern. These issues are classified as ethical dilemmas because a researcher is required to obtain informed consent from participants before they engage in any form of study (Gupta 2015). However, some participants may not be in a position to make the right decisions or give informed consent due to dependence on drugs and age. In the case of intervening illicit substance use among indigenous Australians, health promotion is not reaching its limits because a lot can be done to address the problem. The last section of this paper will give an evidence-based intervention protocol that could be used to help the affected individuals overcome this health problem.
Planning Intervention using Minority Stress Theory
The minority stress theory operates in the context that the more minority groups are marginalised and excluded from socio-economic benefits and opportunities, the more they are likely to experience negative health outcomes, such as drug abuse (Goldbach et al. 2014). In this case, the majority of Aboriginal Australians are forced to use illicit substances because due to lived or perceived stigmatisation associated with colonisation, dispossession, and marginalisation. As such, any form of intervention should focus on reversing the mind-sets of the affected individuals. Understanding the causes of certain behaviour should be the starting point of any successful intervention measure. Therefore, by using the premise of the minority stress theory, it becomes easy to choose a behaviour change theory to address the problem. Based on the causes of illicit substance usage among Aboriginal Australians, the social norms theory (approach) is the best-suited behaviour change theory to be used in the intervention protocol.
Social Norms Theory
The social norms theory is one of the commonly used approaches in promoting positive health-related behaviours. According to Dempsey, McAlaney and Bewick (2018), the social norms approach operates on the “premise that individuals misperceive their peers’ behaviours and attitudes, with evidence of under- and overestimations of behaviours and peer approval for a range of positive and negative behaviours respectively” (p. 1). In this case, the more the misconceptions, the higher the chances of engaging in the use of illicit substances teenage Aboriginal Australians. Therefore, this theory could be used successfully to create an intervention plan because it seeks to understand the environment and interpersonal influences in a bid to initiate behavioural change.
The social norms theory relates to the behaviour (use of illicit substances) and population (teenage Aboriginal Australians) under study because it addresses the causes of the problem. For instance, the theory will look into the risk factors, such as marginalisation, effects of colonisation, stigmatisation and associated consequences including homelessness, drop out from school and dependence on welfare, to create targeted intervention plan. By understanding the underlying causes of the behaviour, through the social norms approach, it becomes easy to come up with functional, applicable, and effective intervention measures that could address the problem sustainably.
Normative beliefs and peer influences play a significant role in the use of illicit substances by teenage Aboriginal Australians. Peer influences are subject to perceived norms (what is viewed as standard or typical within a group) as opposed to the actual norm (the real actions or beliefs of a group) (Davis et al. 2016). The gap between these two forms of perceptions is a misperception, which forms the basis for the implementation of the social norms approach. As such, the intervention, in this case, would focus on correcting misperceptions about drug abuse among Aboriginal teenagers in selected schools in Australia. The overall type of intervention would be normative feedback, which is a tool used to create awareness and deconstruct misperceptions concerning the use of illicit drugs in the targeted population. In this case, normative feedback would be provided using social norms messages, which are specific to teenage Aboriginal Australians in schools. The intervention program would have three components – a one-hour normative feedback session, posters, and web-based application.
In the first component (a one-hour normative feedback session), schools would receive feedback sessions on the theory of social norms together with learning about the discrepancies that exist between the perceived and actual use of illicit substances among teenagers under the guidance of a trained moderator. Under the second component (posters), schools would receive 5-10 posters with specific social norms messages. Teachers would be requested to display the posters throughout the intervention period after the normative feedback session. Finally, the third component (web-based application) would involve instructing students to open web-based applications on their smartphones or computers to evaluate their social misperception and get information concerning the actual behavioural norms among their peers.
This intervention program is justified because it seeks to understand the causes of the problem and offers evidence-based solutions. The messages delivered through the different components would be framed to challenge potential overestimations of peer behaviour and attitudes towards the use of illicit substances. According to Smith et al. (2015), normative feedback is an effective tool in correcting misperceptions and creating a readiness to change among adolescents. An example of the messages used may include – 9 out of 10 adolescent students in your school have never tried illicit substances.
Each component would have the same messages tailored based on the needs of the schools where they are disseminated. All the components are theoretically effective because they allow students to identify and correct their misperceptions by reconciling them with the actual norms (Stock, Vallentin-Holbech & Rasmussen 2016). Through the first component (one-hour normative feedback session), the trained moderator would engage students to create awareness concerning the misconceptions associated with the usage of illicit substances. As such, students acknowledge the reality that the majority of them are not engaged in such behaviour as opposed to their perceived norms. The second and third components would have the same effect of disseminating the right information to deconstruct myths and misperceptions associated with this behaviour among teenage Aboriginal Australian students. As such, all the components fit into the context of the population under study and the behaviour to be changed.
Additionally, the intervention type (normative feedback) and the three components as identified earlier fit into the social norms theory, which is the change theory selected for this intervention. This theory works on the premise that people misperceive their peers’ behaviour and attitudes through overestimations (Vallentin-Holbech, Rasmussen & Stock 2018). For instance, teenage Aboriginal Australian students may think that their peers use illicit substances to escape poverty, marginalisation, and stigmatisation. However, through the normative feedback intervention messages delivered via the three mentioned components, students would realise that most of their peers are not engaged in such behaviour. This realisation would delay or prevent the onset of drug abuse among the targeted students or create readiness for change for those already engaged in the behaviour. This argument underscores the link between the social norms theory and the intervention type and components selected for this program.
The appropriate setting for the implementation of this intervention is in schools. This set-up would be the most suitable to reach to the targeted population (Hennessy & Tanner-Smith 2015). Schools would be selected randomly from identified regions in Australia and be invited to participate in the trials. One of the strengths of this approach is that evidence-based results would be achieved at the end of the study. The randomised nature of the study would allow for the generalisation of results in other regions. However, some limitations include implementation barriers whereby the study population would be limited to certain areas to minimise the costs associated with the program. Additionally, long-term follow-ups may not be possible given that students transition from different levels of education in diverse learning institutions.
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