Head Health and Healing - Empowering Indigenous women and the frontline workforce to respond to violence-related concussion through co-designed education and training

Traumatic brain injury (TBI) is a common injury from violence that has lasting impacts on the brain. Our research in 2022-23 (ARC DE210100639) found that Aboriginal and Torres Strait Islander women felt they did not receive adequate information either in hospital or at their local community clinic to understand their injury, how physical violence changes brain function and strategies to manage daily symptoms. Furthermore, longstanding frontline workforce characteristics affect consistency of TBI education provided in rural and remote Australia, including: 1) high heath workforce turnover; 2) lack of visiting neuropsychological services; and 3) low skills of the frontline workforce to ask about TBI and action appropriate referrals. Aboriginal and Torres Strait Islander communities in central and northern Australia recommend community- led violence-related TBI education to raise TBI awareness as well as strengthen responsive supports for Aboriginal and Torres Strait Islander women. This project responds directly to this recommendation. 

Aims - This project will deliver valid, reliable, and community co-designed TBI education resources and training modules that will be integrated into healthcare protocols. Our specific aims are to: 

• Develop accessible, effective and credible, co-designed consumer-friendly education resources; 
• Facilitate improved understandings of Aboriginal and Torres Strait Islander women’s violence related TBI risk factors and TBI needs; 
• Develop effective and culturally appropriate frontline workforce violence-related TBI training modules to ensure that staff are fully equipped to provide the necessary support during recovery. 

Methods - This project consists of two phases: 

Phase 1 (0-24 months; 2025-26) - Co-design workshops and interviews for TBI education and training modules 

Four participant groups will inform the education resources and training modules: a) Aboriginal and Torres Strait Islander women, aged 18+ who have experienced violence-related TBI; b) family members, c) community members, and d) frontline workforce. The content and training guidelines will be developed over three rounds of yarning workshops in Alice Springs and across five communities in Central Australia. To support research transferability to Indigenous women who experience violence-related TBI nationally and internationally, the initial content generated from Central Australian yarning workshops will be presented to Indigenous women in Townsville (Australia), Toronto (Canada) and Auckland (Aotearoa New Zealand). 

Phase 2 (24-48 months; 2027-29) - Implementation and evaluation of the TBI education and training modules

A mixed method study will be conducted to gather community and workforce perceptions and information on the impacts of created education resources and training modules (e.g., knowledge and skills on the brain, TBI management, healthcare experiences, follow-up and service referrals). We will explore relevancy of the content, barriers and enablers to implement and upscale the resources and training and recommendations for improvement. Aboriginal and Torres Strait Islander women who have experienced violence-related TBI, family members and frontline staff who complete training and education modules will complete interviews over three timepoints. Health staff will also complete an online survey over three timepoints. 

Governance and ethics - Strong Aboriginal and Torres Strait Islander governance is an important aspect of codesign. The team will establish lived experience, cultural and frontline health workforce advisory panels. The research team will apply for ethics approval in mid-2025 through the NT Department of Health and Menzies School of Health Research Human Research Ethics Committee (HREC) and Townsville Hospital and Health Service HREC. Appropriate approvals will also be secured for the women’s learning circles in Toronto and Auckland. 

Outcomes - The educational resources and frontline training modules will strengthen the accessibility, support and recovery of Aboriginal and Torres Strait Islander women who have experienced violence-related TBI and their connection with the services provided in Alice Springs Hospital as well as in remote communities, thereby reinforcing the responses of all services in Central Australia. With senior leadership from national bodies including Australasian College of Emergency Medicine and Synapse Australia, it is envisaged that the outcomes will be implemented in other locations across Australia.