Our Impact

2015

Exploratory Retreat and Coaching

This exploratory phase was completed with the program founders and the 12 pioneering Yolngu women. It involved a 14 days away at Living Valley Health retreat in Kin Kin QLD, including daily "discovery education" discussions about health with a cross-cultural educator in Yolngu matha, then 4 day re-orientation workshop, before returning to community and being supported with health coaching consultations and activities. An intensive 3 months coaching phase followed was followed by ongoing individualised support for at least another 3 months. Anonymised monitoring data showed the following changes in health indicators:

Improvements over 6 months

  • 88% of participants started the health retreat with a BP higher than normal (120/80). At the end, this figure had dropped to 55% with high blood pressure. At the three month mark, all participants experienced an improvement in BP readings; and at six months 90% had retained a marked improvement.

  • 100% of participants experienced a marked improvement of blood lipids (decreased Triglycerides, Increased HDL decreased LDL)

  • 90% of participants had reduced waist circumference; at six months, 50% of the participants had maintained notable improvements.

  • 50% of participants were smokers prior to the retreat; all quit smoking during the retreat. At the three month mark 50% of the previous smokers remained non-smokers; at six months 67% of the original smokers had successfully stopped smoking.

  • Participants reported feeling the best they could remember, and most lost weight. These pioneering women formed a working group to create a program for their community based on their experience.

2016

Pilot Yolngu "on-country" health retreat and coaching program

The success of the previous program inspired the community to support a local and larger Hope for Health program (26 participants) with a retreat held near local hunting grounds incorporating hunting, harvesting, and traditional nutrition and healing. This was followed by 6 months of health coaching support.

Program monitoring results over 3 months

  • 7cm average waist reduction

  • 4.8kg average weight lost

  • All improved their blood lipid markers

  • Blood sugars reduced from Average of 8.3% before to 6.5% (Hba1C), which is the clinical goal for controlled blood sugar.

  • 86% of those with hypertension reduce their blood pressure to less than 140/90

2019

Health Retreat and Coaching program independently evaluated

Our 2019 program trialed delivering retreats in the Darwin rural area, at a facility with established facilities, returning participants to community for 3 months health coaching. The retreat and the health coaching was evaluated by teams from the University of Melbourne and Charles Darwin University.

Summary of findings:

  • Statistically significant reduction in weight (1.4 kg average) and waist measurement (2.6 cm average) after 3 months (this is despite statistically small sample size).

  • “The limited data... is favourable suggesting positive clinical outcomes.”

  • “By the end of the retreat, most of the Yolŋu participants that we spoke to had clear understandings of biomedical relations between diet and health.”

  • “A key outcome for many of the retreat participants was an interest in teaching their new understandings and health practices to their children and grandchildren.”

Michaela Spencer, Michael Christie, Sarah Hanieh, Beverly Biggs, and Joanne Garngulkpuy. 2019. ‘Hope for Health Riyala Retreat April 2019: Evaluation Report’. Evaluation report. Northern Institute, Charles Darwin University. Peter Doherty Institute for Immunity and Infection, University of Melbourne. pp. 59

2022

Large Scale Study of Health Coaching and Retreat Program.

The Medical Journal of Australia paper from the 2022 large-scale research trial of our program is now out!

‘Improving Cardiometabolic Risk Factors in Aboriginal and Torres Strait Islander People in Northeast Arnhem Land: Single Arm Trial of a Co-Designed Dietary and Lifestyle Program’.

Medical Journal of Australia (online only issue to be advised)

Authors: Dissanayake, Hasthi UW, George Guruwiwi, J Dhurrkay, Josh C Tynan, Sabine Braat, Benjamin Harrap, Tim Trudgen, et al. https://doi.org/10.5694/mja2.52593.


Background: Through a partnership with the University of Melbourne (in collaboration with Charles Darwin University, Monash University, Menzies School of Health Research, and Miwatj Health Aboriginal Corporation), funding from the National Health and Medical Research Council (NHMRC) was secured in late 2019. However, program delivery was delayed by two years due to the COVID-19 pandemic. The program aimed to include twice as many participants as in previous years, and despite the challenges of being unable to prepare the community in advance due to lockdowns in these remote areas, 66 participants were successfully recruited in 2022. A small group (15 participants) opted to attend the "on-country" retreat with health coaching, while the majority (43 participants) received only home-based health coaching within the community. Only a small number of participants dropped out. (These figures refer to HFH program participants, not the study participants, whose numbers were slightly lower.) It is important to note that the program and study duration were limited to a four-month intervention due to delays and restricted access to program-specific funding during the COVID-19 pandemic.

Findings

Over 4 months in our in-community health coaching program or 12-day retreat plus health coaching, achieve the following:

Clinical improvements 

18%

of participants achieved at least

5% weight loss

33%

of participants achieved at least

3% weight loss

52%

had clinically significant

improvements in HbA1C (average blood sugar)

These improvements are clinically significant, meaning that these changes, as supported by the medical evidence base, have positive effects on reducing the risk or severity of chronic diseases. In this case, the average weight reductions observed are associated with a reduced risk of type 2 diabetes and lower blood pressure, which in turn impacts many other health conditions. More than half of our participants reduced their risk of diabetes by lowering their blood sugar levels. Notably, although not included in this paper, 32% of participants achieved a reduction in HbA1c of 0.5% or more (unpublished data). This level of improvement is one that a local GP would celebrate in a patient. For example, for someone in a prediabetic state, a reduction of >0.5% in HbA1c could potentially mean returning to normal blood sugar levels.



Behavioural changes

Achieving behavioural changes through preventative interventions is often considered challenging to accomplish and sustain. However, our program successfully demonstrated behaviour change that aligned with its goals, even with minimal intervention for most participants, consisting of just an initial health check and a health coaching consultation.

southBreads, Cereals, Sugar-DrinksReduced consumption by participants averaging 1.5 serves/day
north103 Min Avg./dayIncrease in moderate to vigorous activity

This movement outcome is remarkable, demonstrating a significant self-motivated effort by most participants to increase their daily activity levels. While the program encourages physical activity through its educational content, retreat activities, and community initiatives, these are not provided on a daily basis outside of the retreat or during movement monitoring. Therefore, this outcome cannot be solely attributed to program activities, especially considering that only 20 out of 60 participants attended the retreat. It is also possible that wearing the movement monitors played a role in motivating participants to increase their activity, particularly among those who were already more self-motivated.

Improvements in Nutrition 

Studies of food consumption in remote Aboriginal communities indicate a tendency to overconsume sweet sugars, particularly through sweetened drinks, as well as refined or processed carbohydrates such as flour, bread, and other cereals. Data on consumption, measured through store purchasing, also highlights inadequate protein intake. Our traditional diet approach focuses on education aimed at encouraging increased consumption of meats and vegetables while reducing the intake of sweet sugars and refined or processed carbohydrates. Although the study did not show an increase in vegetable consumption, participants made choices aligned with these goals by significantly increasing their meat consumption and reducing their intake of sweetened drinks and refined carbohydrate sources.



Sustainability of change question

Given that the study lasted only four months, the sustainability of the observed changes is unknown. (A longer study had been planned but was cut short due to COVID-19 delays and funding challenges.) Our previous programs, which have run for 6-12 months, provide internal data showing that changes can be sustained over six months while health coaching support is available (e.g., see 2015 results above).

Our steering committee believes that the continuous availability of our Health Coaching service is essential to achieving long-term change in these communities. Behaviour change is challenging, and our members have found that they often need "pathways" of support and learning that they can return to over time. For example, a six-month initial program with a 12-month follow-up check can provide a foundation of knowledge and experience. However, participants may need to re-join the program a few years later if new challenges arise.

This is why we believe the next step beyond the research is to deliver and evaluate a continuous, long-term service. Such a service would ensure the ongoing presence of peer groups and in-community health-promoting activities, creating spaces for peer support to help individuals navigate the difficulties of lifestyle change.

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