Development and preliminary validation of the 'Caring for Country' questionnaire: measurement of an Indigenous Australian health determinant
Date
2008-12-18
Authors
Berry, Helen
Burgess, Christopher P
Gunthorpe, Wendy
Bailie, Ross
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BioMed Central
Abstract
BACKGROUND: 'Caring for Country' is defined as Indigenous participation in interrelated activities with the
objective of promoting ecological and human health. Ecological services on Indigenous-owned lands are
belatedly attracting some institutional investment. However, the health outcomes associated with
Indigenous participation in 'caring for country' activities have never been investigated. The aims of this
study were to pilot and validate a questionnaire measuring caring for country as an Indigenous health
determinant and to relate it to an external reference, obesity.
METHODS: Purposively sampled participants were 301 Indigenous adults aged 15 to 54 years, recruited
during a cross-sectional program of preventive health checks in a remote Australian community.
Questionnaire validation was undertaken with psychometric tests of internal consistency, reliability,
exploratory factor analysis and confirmatory one-factor congeneric modelling. Accurate item weightings
were derived from the model and used to create a single weighted composite score for caring for country.
Multiple linear regression modelling was used to test associations between the caring for country score
and body mass index adjusting for socio-demographic factors and health behaviours.
RESULTS: The questionnaire demonstrated adequate internal consistency, test-retest validity and proxyrespondent
validity. Exploratory factor analysis of the 'caring for country' items produced a single factor
solution that was confirmed via one-factor congeneric modelling. A significant and substantial association
between greater participation in caring for country activities and lower body mass index was
demonstrated. Adjusting for socio-demographic factors and health behaviours, an inter-quartile range rise
in caring for country scores was associated with 6.1 Kg and 5.3 Kg less body weight for non-pregnant
women and men respectively.
CONCLUSION: This study indicates preliminary support for the validity of the caring for country concept
and a questionnaire designed to measure it. This study also highlights the importance of investigating
Indigenous-asserted health promotion activities. Further studies in similar populations are merited to test
the generalisability of this questionnaire and to explore associations with other important Indigenous
health outcomes.
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International Journal for Equity in Health 7.26 (2008)
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International Journal for Equity in Health
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Journal article
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