The Role of Sport and Recreation in Indigenous Communities: Challenges and Opportunities, Lecture notes of Literature

Download The Role of Sport and Recreation in Indigenous Communities: Challenges and Opportunities and more Lecture notes Literature in PDF only on Docsity!

i

Investigating indicators

for measuring the

health and social

impact of sport and

recreation programs in

Indigenous communities

Mary Beneforti and Joan Cunningham

ii

CITATION

Beneforti, M. and Cunningham, J., 2002, Investigating indicators for measuring the health and social impact of sport and recreation programs in Indigenous communities, Australian Sports Commission and Cooperative Research Centre for Aboriginal and Tropical Health, Darwin.

The ideas and opinions presented in this report do not necessarily reflect the ideas and opinions of the Australian Sports Commission (ASC) or the Cooperative Research Centre for Aboriginal and Tropical Health (CRCATH).

General inquiries about this publication should be directed to:

Cooperative Research Centre for Aboriginal and Tropical Health PO Box 41096 Casuarina NT 0811

ISBN 1 876831 55 3

Cover design and layout by Sarah Walton, CRCATH Edited by Sally Matthews and Michael Duffy Photographs provided by the Australian Sports Commission The Australian Sports Commission and the Cooperative Research Centre for Aboriginal and Tropical Health funded this project.

iv

FOREWORD

Having lived and travelled in the Northern Territory all of my life I have seen the positive dif- ference that sport and recreation can make to people’s lives. As such, I have been a long- time advocate of sport and recreation programs, particularly in remote communities.

This report highlights the potential benefits from participation in physical activity and the importance of viable and sustainable programs to support involvement in sport and recre- ation.

With more than 35 per cent of the Indigenous population of the NT under the age of 15 years, sport in particular offers an avenue for engaging young indigenous people in com- munity activities.

As the Northern Territory’s Sport and Recreation Minister, I am keen to develop partnerships with bodies like the Australian Sports Commission and the Aboriginal and Torres Strait Islander Commission. We should work together to deliver more structured sport and recre- ation programs to isolated communities and encourage community ownership of the pro- grams and processes. Following successful initiatives in the regional delivery of primary health care and housing, I am particularly interested in ways this might be delivered at regional as well as community levels.

Concomitant with program implementation and resourcing is the need to develop measures to assess effectiveness and the impact on various community health and social outcomes. This report identifies a range of variables that can be used to assess potential benefits from delivery of sport and recreation programs, such as reduced levels of criminal behaviour, tru- ancy, domestic violence, substance misuse and self-harm. Although further development of these indicators and other outcome measures are required, communities and funding agen- cies need to ensure that evaluating effectiveness and monitoring community impact are an integral aspect of the program planning and delivery process.

Much work is still to be done but this report gives encouragement to those who seek to improve our community’s health profile by increasing participation in physical activity.

I encourage all Australians to work together to find the best methods for delivering improved health and social conditions for our people.

John Ah Kit MLA Minister for Sport and Recreation

v

ACKNOWLEDGEMENTS

Thank you to the many people who assisted with this project including:

The members of the management group for the project:

Joan Cunningham (Co-investigator, Menzies School of Health Research) Darren Godwell (Co-investigator, Lumbu Indigenous Community Foundation) Ian Ford (Project Manager, ASC) Tony Barnes (Project Manager, CRCATH)

Glenn Brennan, Indigenous Sports Program National Manager, ASC.

Peter Ryan and Matthew Turner from the Department of Community Development, Sport and Cultural Affairs who kindly took Mary Beneforti along with them on their field visits to com- munities.

The residents of the three Indigenous communities that Mary visited for welcoming her and sharing their time and thoughts with her. This report draws extensively on their input.

The reference group members:

Peter Atkinson, Joel Kelly (AFLNT)

John Law, Jonathan McLeod (ATSIC)

Graham Opie, Melissa Farrington (National Heart Foundation, NT Division)

Peter Ryan, Jackie Antoun, Patrick Minniecon (NT Department of Community Development, Sport and Cultural Affairs)

Gregory Smith (NT Department of Health and Community Services)

Stephen Farrawell, Tom Redston (NT Department of Justice)

Dennis McDowall (NT Indigenous Sports Council)

Kym Davies (NT Police, Fire and Emergency Services)

Daryl Little (SA Office of Recreation and Sport)

Brian Deslandes (SHAPES)

Trevor Woodhead (Woodhead Consultants)

And the many others who provided input: Snowy Day, George Shorrock, Grant Butler, Blair Cheshire, Al Harvey (sport and recreation officers), George Butler (sport and recreation, Anyinginyi Congress Aboriginal Corporation), Nick Rowe (Sport England), Pam Gollow (NT Department of Health and Community Services), David Kerrin (Department of Community Development, Sport and Cultural Affairs), Mary Tennant (Institute for Child Health Research, WA), Helen Parker (University of Notre Dame, WA), Elizabeth Eakin (Queensland University of Technology), Caroline Sheehan (VicHealth), Adriana van den Heuvel (Australian Bureau of Statistics), Roz Walker (Curtin University, WA), Sallie Cairnduff (formerly of NT Department of Health & Community Services), Brenton Toy (AFLNT), Geoff Dane (ATSIC).

vii

DEFINITIONS

Indigenous

In this report, the word ‘Indigenous’ is used to refer to Aboriginal and Torres Strait Islander people. In some cases, ‘Aboriginal’ is used instead of ‘Indigenous’. This is because a title or a particular piece of work being referred to uses this term or refers specifically to Aboriginal people.

Outcomes/impact

These terms are used interchangeably in this report and can be defined as follows: ‘Out- comes reflect the net effect of the program on the target population. They show the impact the program has on the original problems or identified need, who receives assistance, and the impact of the program on people’s well-being’ (Department of Premier & Cabinet Victoria 1988, p.16).

Sport and recreation programs

In this report, sport and recreation programs refer to all organised physical and recreational activities. In an earlier report (Cairnduff 2001), the term ‘sport and recreation’ was restricted to all organised physical activities but for this report, the definition has been extended to include organised activities that do not have or that have only a small physical component. The definition includes activities of both a competitive and non-competitive nature and can include activities such as community sporting competitions, community carnivals, recre- ational swimming, after-school activities, and discos. This is because it is often difficult to separate physical activity outcomes from recreational outcomes. The sport and recreation officer in a community is responsible for both physical and non-physical activities. Health and social outcomes may be just as likely to be achieved through a sporting competition as through having the sport and recreation hall open at night for videos and playing pool. Health and social outcomes can also be achieved through ‘non-playing’ participation such as volunteering.

Community sport and recreation officers

Community sport and recreation officers are based in Indigenous communities. Their posi- tions are funded by State/Territory governments, community councils and other agencies.

Indigenous Sports Program (ISP) officers

ISP officers are funded by the Australian Sports Commission through the Indigenous Sports Program. There is one ISP officer for every Aboriginal and Torres Strait Islander Commission (ATSIC) region. ISP officers liaise with and assist community sport and recreation officers.

viii

EXECUTIVE SUMMARY

This report presents the findings of a project to identify potential indicators of health and social outcomes from sport and recreation programs in discrete Indigenous communities. An earlier report identified this as a research priority (Cairnduff 2001).

As a result of the project, a number of indicators are proposed for immediate testing and refinement, and others are recommended for future development. These indicators are pre- sented in the table on page xi.

The indicators are intended for use for the routine monitoring of sport and recreation pro- grams in discrete Indigenous communities.

Methodology

A project management group was established to oversee the project. A reference group was also convened to provide expertise and guidance.

The project consisted of three stages:

• A review of national and international literature was conducted to identify spe- cific indicators that could be relevant to Indigenous sport and recreation pro- grams. More general information on processes used to develop appropriate indicators was also sought. In addition, sport and recreation providers and researchers were contacted for information about any indicators currently used to evaluate programs.
• Discussions were held with key members of three discrete Indigenous commu- nities in the Northern Territory that are implementing sport and recreation pro- grams. The discussions helped identify the expectations that community residents have of sport and recreation programs and their beliefs about what makes pro- grams succeed. Analysis of the information obtained during the visits was used to help select appropriate indicators.
• Consultation with the project management and reference groups as well as other interested parties was undertaken to help determine the potential usefulness and appropriateness of the identified indicators.

Findings

The literature review

It is evident from the literature review that indicator development on outcomes from sport and recreation programs (for the general population and even more so for Indigenous popula- tions) is in its infancy. Research evidence on the links between sport and recreation programs and various health and social outcomes is also limited. To date, most research has focussed on exploring the links between physical activity and various health outcomes. However, this work has essentially been confined to the realm of targeted research and has not extended to routine monitoring and evaluation of service delivery. Where program evaluation has been attempted, the results have often been inconclusive. Anecdotal and qualitative evidence sug- gests that sport and recreation can directly or indirectly influence a number of areas of social concern in Indigenous communities such as crime, school attendance, substance abuse, self- harm, violence and social cohesion. More work is needed to provide stronger evidence of these relationships.

x

an association between the sport and recreation program and the outcome; by community doubt as to the relevance of such indicators to their communities; and by issues of practical and culturally relevant measurement. These indicators are recommended for further research and development.

Important contextual considerations

Developing a set of indicators demands consideration of the context in which Indigenous community sport and recreation programs operate. Discussions with stakeholders and com- munity members revealed that high turnover of community sport and recreation officers and lack of stability of programs is a common situation that has existed for many years and that appears to be accepted as a ‘fact of life’. Although stakeholders frequently mentioned the need for sport and recreation programs to function as part of a ‘whole-of-community’ approach to be successful, there seemed to be little integration of the sport and recreation program with other aspects of community life. Sport and recreation officers reported that they sometimes felt isolated as they tried to provide for the needs of many, with the support of few. This reportedly could lead to burn-out, sometimes eventuating in the sport and recreation officer cutting short his/her stay in the community. Although it may be possible to achieve health and social outcomes from sport and recreation programs in this unstable environment, it is clearly a challenging task.

The long-term sustainability of sport and recreation programs in Indigenous communities would ultimately seem to rest on the ability of communities to run programs without extensive support from outside - although a safety net of financial and human resources would be required to assist communities to maintain and build upon their success. Many stakeholders concurred on the importance of building the capacity of communities to the extent that local residents could deliver and manage the sport and recreation program themselves. This would enable non-resident sport and recreation officers to then move on to more needy communi- ties. Working towards such an objective would necessarily broaden the role of the sport and recreation officer to include more community consultation, relationship building and skills transfer. As sport and recreation officers consistently reported the need for more assistance, government departments, community councils and other managing bodies would need to recognise and embrace such an approach by adopting systems and structures which would support the sport and recreation officer to work in this manner.

Future directions

The proposed indicators are still in a formative stage. Each of the indicators needs to be tested before being recommended for routine use. The function of the indicators as an inter- related set also needs to be assessed. Preliminary work would involve:

• seeking stakeholder agreement on the final set of indicators to test
• refining the indicators to establish measurement methods and benchmarks
• finding out more about data availability and data quality
• and talking with communities, stakeholders and researchers to identify who would be involved in a testing program.

Priority should be given to the program viability and sustainability indicators, particularly those relating to turnover of officers and the length of time the officer has been in the posi- tion. Such information is not difficult to collect and will provide a better picture of turnover than that which currently exists.

Further research needs to be conducted into the relationships between sport and recreation programs and health and social outcomes, so that a stronger evidence base can be devel- oped. This will assist in determining the validity of those indicators which have been recom- mended for future development so that they may ultimately be used for the routine monitoring and evaluation of sport and recreation programs in Indigenous communities.

xi

Proposed indicators by type and priority category 1, 2

Program viability and sustainability indicators

Prerequisite 1. Turnover of sport and recreation officers in the community

2. Length of time the current sport and recreation officer has been working in the position in the community

Critical 3. Scheduling of activities at appropriate times

4. Assistance given by local community residents
5. Funding for the sport and recreation program

High 6. Qualifications and/or past experience of the sport and recreation officer

7. Satisfaction that the community council or other com- munity leadership group expresses with the sport and recreation program provided
8. Confidence that the sport and recreation officer expresses in the current capacity of local community residents/assistants to organise and run activities them- selves
9. Confidence that the sport and recreation officer expresses in current working relationships with key groups in the community

Medium 10. Succession planning for sport and recreation

11. The sport and recreation officer’s assessment of the adequacy of current facilities and equipment

Participation indicators

High 12. Participation rate for community sport and recreation programs

Outcome indicators - Group 1 3

High 13. Episodes of ‘minor’ (youth) crime Community-specific 14. School attendance

Outcome Indicators - Group 2 4

Community-specific A. Employment of local community members in sport and recreation or related work B. Health clinic attendances C. Episodes of family violence D. Arrests and apprehensions for alcohol or other drug- related offences E. Night patrol client interactions F. Number of (petrol) sniffers G. Episodes of self-harm

1. A standard reporting period, e.g. 12 months, is implied. 2. The priority categories ‘critical’, ‘high’ and ‘medium’ have been assigned according to the relative importance of each indicator to the overall success of the sport and recreation program, based on the project’s fi ndings. ‘Community-specific’ indicators may not have relevance in all settings. Within each priority category, indicators have equal status. 3. Group 1 indicators are those where there is reasonable evidence in the literature and in practice of an association between the sport and recreation program and the outcome, where community members have stressed the importance of this outcome, and where the outcome lends itself to practical and culturally relevant measurement. 4. Group 2 indicators are potential indicators that require further development.

1. INTRODUCTION

Background

Sport is recognised as a potentially powerful force in Indigenous community life. The Royal Commission into Aboriginal Deaths in Custody (RCIADIC) described sport and recreation as an important antidote to boredom that was a key factor in the prevention of Aboriginal juvenile crime (Johnston 1991). Tatz (1995) suggested that sport can provide a ‘centrality’ to Indigenous communities, an essential ingredient for their political and cultural survival.

Sport and recreation has also been noted in the literature as having the potential to reduce levels of substance use and self-harm, and to improve social cohesion in Indigenous com- munities (Cairnduff 2001; Cameron & MacDougall 2001; Walker & Oxenham 2001).

Physical activity is recognised as important to maintaining good physical and mental health and preventing the onset of chronic diseases (Bauman et al. 2002). The Australian Indig- enous population suffers high rates of illness and mortality due to chronic diseases such as heart disease and diabetes (ABS & AIHW 2001). It has been estimated that physical inactivity causes seven per cent of the total disease burden in Australia (Mathers et al. 2000).

Little is known about the current levels of participation in physical activity by Indigenous Australians. (although participation levels at the national and state levels will become avail- able through the Australian Bureau of Statistics’ Indigenous Social Survey to be conducted in 2002). Little is known also about the impact of sport and recreation on Indigenous people and on Indigenous communities. A recent report furthered knowledge in this area. At the request of the Australian Sports Commission (ASC), the Cooperative Research Centre for Aboriginal and Tropical Health (CRCATH) conducted a project in the Northern Territory (NT) to identify potential areas of research in the Indigenous sport and recreation sector (Cairnduff 2001).

Cairnduff (2001) explored the reported links between sport and recreation and health; identi- fied the main stakeholders in sport and recreation delivery in the Northern Territory; elicited information on programs in Indigenous communities such as their objectives and expected outcomes; and developed a proposal for further research in the area.

The project found that the greatest research priority was to provide more evidence of the impact of sport and recreation programs. A wide range of expected outcomes of programs was identified by agencies in the Northern Territory, including:

• increased Indigenous participation in sport and recreation activities
• improved educational outcomes
• improved physical and emotional health
• provision of diversionary activities for young people
• and provision of employment opportunities for Indigenous people.

Evidence of achieving such outcomes, however, is to date largely anecdotal. There has also been little analysis of the long-term impacts of sport and recreation programs.

It was found that central to the need for evidence of the outcomes of programs was the lack of appropriate indicators to monitor programs and to measure their social and health impact. The project also highlighted the very limited information on the expectations of remote com- munities of sport and recreation programs. It was recommended that discussions with com- munities be conducted to elicit community views on what constitutes a ‘successful’ program in order to determine indicators that reflect community expectations.

These findings led to the current project, which is a joint project of the ASC and the CRCATH. The project’s aim was to identify appropriate indicators to measure the social and health impact of Indigenous sport and recreation activities.

Project design

A group consisting of the project managers from the ASC and the CRCATH and experts in the sport and recreation field was convened to oversee the project. A reference group of relevant stakeholders and interested parties was also formed and provided advice on Indigenous sport and recreation and related programs in the Northern Territory and elsewhere. (See the Acknowledgements for a list of management and reference group members). In addition, many people from around Australia and overseas, from the sport, physical activity, evalua- tion, and statistical arenas provided their thoughts on the project.

The first stage of the project involved a review of national and international literature in order to identify information on indicators relevant to Indigenous sport and recreation programs (see chapter 2). Sport and recreation providers and researchers were also contacted for infor- mation about any indicators currently used to evaluate program (see Chapter 3).

The second stage involved a series of discussions with three discrete Indigenous communities in the Northern Territory that are implementing sport and recreation programs. The discus- sions helped identify the expectations that community residents have of sport and recreation programs and their beliefs in what makes programs succeed (see Chapter 4). Analysis of the information obtained during the visits was used to help identify appropriate indicators.

The third stage involved consultation with the project management and reference groups as well as other interested parties to help determine the potential usefulness and appropriate- ness of identified indicators. The indicators are presented in Chapter 5. This report was also circulated back to the communities who participated to seek their feedback.

Project scope

Health and social outcomes were explored in the context of discrete Indigenous communities. Such communities are mostly located in remote parts of Australia. Time and funding for the project allowed for visits to three Indigenous communities in the Northern Territory.

Early plans for the project also included the possibility of discussions with residents in com- munities in other states and territories. This did not occur due to the short timeframe for the project and a longer time than expected being required to set up and conduct the visits in the Northern Territory. However, the indicators were circulated to a number of stakeholders in other states and feedback has been incorporated into this final report.

Project Limitations

Community visits were limited to three three-day visits within the Northern Territory. This cannot be considered representative of all Indigenous communities in the Northern Territory, although considerable overlap was found in the themes raised in the three communities. The time spent in each community was also brief and undoubtedly, some people who would have liked to have input were missed.

Visits were not conducted in other states therefore it is not known how well the findings in the Northern Territory represent the situation in other parts of Australia. However, the literature suggests that many remote Indigenous communities in other states experience similar issues to those of the Northern Territory.

Indicator development

Background

The use of indicators to monitor and evaluate programs and policies is not new, particularly in the economic field. Health indicators are also commonly in use. Much is happening in the USA in the area of community indicators, designed to form a report card on a community’s progress (Miringoff & Miringoff 1999). Entire websites have been set up to assist communities in the planning, delivery, and evaluation of programs (e.g. refer the United Way website: www.national.unitedway.org and the Healthy Communities website: www.healthycommunities.org). A number of social and community indicator projects also exist or are under development in Australia e.g. the National Citizenship Indicators, Tasma- nia Together project and the Victorian Government Social Benchmarks and Indicators. See Salvaris (2000) for a review of national and international indicator projects.

Definitions

Definitions of indicators range from the dry and specific - ‘a statistic or unit of information …’ (NHIMG 2000) - to the poetic - ‘a metaphor ... a glimpse of a broader social context’ (Miringoff 1999, p.16).

Indicators can be either direct or indirect measures of anticipated outcomes and are often imperfect measures of abstract constructs (Ministry of Health Manatu Hauora (NZ) 2001), a ‘crude, fragmentary impression of a complex reality’ (O’Shaughnessy 2001, p.52). There- fore, indicators should be just one element of a broader evaluation strategy. As some authors have cautioned, an ‘over-emphasis on the use of indicators or measures can result in a par- tial rather than complete description of the impact of a program’ (Owen & Rogers 1999, p.260).

Terminology

The literature frequently employs terminology related to input, throughput or process, output and outcome indicators. These are described in more detail below:

Outcome indicators

Outcome indicators attempt to measure the effect or impact of programs or interventions. O’Shaughnessy (2001) found little evidence pertaining to outcome indicators in performance indicator systems or specific evaluation studies. Reasons for this included uncertain causal relationships between intervention and change; costs of establishing and maintaining out- come-monitoring systems; lack of know-how; and the fact that outcome indicators are harder to develop than output indicators (O’Shaughnessy 2001).

Input, throughput and output indicators

Input indicators can be used to reflect inputs such as financial and human resources. Throughput (activity or process) indicators describe the use made of these inputs, such as provision of training courses and number of participants registered in programs. Outputs refer to completed activities such as the number of people trained or the number of people completing a program (O’Shaughnessy 2001). In practice, the terminology of input, through- put and output indicators may not always be clear-cut as some inputs or activities may be outputs of other activities e.g. the development of a plan for a sport and recreation program may be both the output of one project and a necessary input to a new program.

Frameworks

A conceptual framework can assist in interpretation of the indicators. For example, the project working group that refined a set of national performance indicators of Aboriginal and Torres Strait Islander health developed a conceptual framework to clarify the relevance of each indicator (Mackerras 2000). This was based on feedback from stakeholders that the existing indicators appeared to lack a conceptual basis for their selection.

The use of a framework also helped identify ‘the level of development of existing indicators, draw attention to areas where indicators are lacking, highlight gaps and deficiencies in the organisation and availability of relevant information, and show where improvements to infor- mation systems are needed’ (CRCATH 2000, p.21).

Cultural values

Where indicators are for use in particular cultural contexts, it has been recommended that the indicators incorporate the cultural values of the people (Gadacz 1991). For this project, this meant finding out what is relevant to Australia’s Indigenous people in the sport and recreation field, and how to collect data in culturally appropriate ways that are acceptable to Indigenous people. Walker et al. (2002) suggest that ‘it is necessary for evaluations of programs and services in Indigenous contexts to assess whether the outcome contributes to Aboriginal self-determination and whether the process is participatory and empowering for the individuals and communities involved’ (p.26).

Selection

In identifying and choosing appropriate indicators, key questions include who are the indi- cators for?, how and where will they be used? and to whom will they be reported? (Sport England 2001). Indicators need to be closely linked to the key outputs and outcomes of the programs or policies they are designed to measure.

Through the literature review, a set of criteria to assist with selection of the final indicator set was identified. Broad consensus was found for the following criteria:

• Valid - the indicator must reflect the event or activity it purports to reflect
• Reliable - under identical conditions, the indicator should give the same answers
• Understandable - the indicator should preferably deal with a single clear idea and should be easily understood by users and stakeholders
• Relevant - the indicator should address major issues, measure something that people care about, be culturally relevant, and should be linked to desired out- comes
• Actionable - there should be actions that have been demonstrated to be able to alter the course of the indicator
• Measurable - there need to be data available and/or it must be feasible to col- lect the desired data; for Indigenous populations, data collection should be cul- turally appropriate and acceptable to Indigenous people
• Acceptable - there needs to be agreement among stakeholders as to the inclu- sion of the indicator (Chrvala & Bulger 1999; CRCATH 2000; Ministry of Health 2001; Salvaris et al. 2000; Walker et al. 2002).

Factors that may assist in selecting a final set of indicators include the number of indicators (less is better) and comprehensiveness (the set of indicators should attempt to ‘tell the whole story’) (Ministry of Health Manatu Hauora NZ 2001).

Indicator development for physical activity/sport and

recreation

The following examples of indicator development for the sport and recreation/physical activ- ity fields were uncovered during the literature review. The examples highlight the diverse nature of sport and recreation programs from broad-based community programs to elite athlete development and the different forms that evaluation might take from program-specific performance indicators through to population surveys.

The Canadian Fitness and Lifestyle Research Institute (CFLRI) monitors the physical activity behaviours of Canadians through its Physical Activity Monitor. This assists the Canadian gov- ernment in tracking progression towards the goal of reducing the physical inactivity levels of Canadians by 10% by the year 2003. The 1999 survey monitored performance in the areas of availability of and access to sport and recreation activities, and the quality of sport and recreation delivery and facilities in Canada (Craig et al. 2001).

Badenoch (1998) described the desirable characteristics of effective wilderness adventure programs for youth at risk. He proposed a best practice performance indicators profile of an ‘ideal’ wilderness adventure program, based on certain highly desirable program character- istics. Badenoch suggested that this profile could be used to gauge the likely effectiveness and success of a specific program. The profile is categorised into five interrelated domains of program design and delivery; staff; funding and resources; management; and evaluation (Badenoch 1998).

In summary, the existing work on indicator development in the sport and recreation arena is not extensive. The evaluation framework developed by Sport England suggests that a bal- anced and multi-faceted approach is needed, with a focus not just on outcomes, but also on the inputs and outputs that produce those outcomes.

Identifying potential indicators

As the literature did not provide clear direction, three questions were used to elicit potential indicators to measure the impact of Indigenous sport and recreation activities:

1. Which of the outcomes of sport and recreation have the strongest research base? There needs to be reasonable evidence that an established association (but not necessarily a direct or causal relationship) exists between the activity and the desired outcome. Much of the work in this area is to do specifically with exercise and physical activity rather than sport and recreation. Some areas of research in the sport and recreation field are still relatively under-developed. Consequently there is limited evidence for some relationships between sport and recreation and potential outcomes. The lack of evidence does not necessarily mean, however, that there is no relationship.

2. What appear to be the components of successful sport and recreation/physical activity programs? The basis for including this question is that something can be learnt from programs that are working. The components of successful existing programs could provide guidance as to the essential components for new pro- grams. Indicators could then be identified to measure whether these components have been put in place. Information about ‘success’ has been obtained through examples in the literature of qualitative evaluations and reviews of programs. Anecdotal evidence often forms the basis of such work.

3. Which of the above outcomes and program components are likely to be most relevant to Indigenous people and measurable in an Indigenous context? The basis for this question is that it cannot be assumed that, just because an outcome is desirable from a health or social perspective for the general population, it will be considered by Indigenous people to be relevant to them. On the other hand, some outcomes may not seem relevant to Indigenous people but may be highly relevant to government or other funding agencies. Outcomes do need to be measurable in the context of Indigenous communities, however. Certain data collection and measurement techniques may not be culturally appropriate. Data availability and quality may be influenced by the setting (e.g. small numbers). The literature can only provide a partial answer and needs to be complemented by speaking to Indigenous people themselves.

The research evidence linking physical activity with health and social outcomes

Although each of the outcome areas is considered separately below, it is likely that there are complex interactions between them. For example, physical health and mental health are interrelated. Mental health, self-esteem and psychological wellbeing are also closely related.

The literature review revealed very few instances of work in these areas for Indigenous popu- lations in Australia or elsewhere. The conclusions reached through the research are assumed to apply to all people regardless of background, but this may be a simplistic assumption. Because physical activity may influence outcomes through a number of indirect mechanisms, it is probable that people’s values, including the values of cultural groups, will impact on the final outcomes.

Economic indicators such as predictions of money saved by preventing chronic diseases have not been explored in this literature review. The area was considered to be highly complex and not able to be covered adequately within the time frame.

Physical health

There is wide consensus based on extensive research that adequate amounts of moderate to vigorous-intensity physical activity has certain physiological benefits such as increased cardiovascular fitness, improved blood pressure, improved insulin sensitivity, weight control, stronger bones, long-term prevention of chronic disease and reduced mortality (refer US Department of Health and Human Services 1996 for a summary of research findings in this area). It is unclear in many cases what ‘doses’ of physical activity are necessary and how this may vary with the individual (Craig et al. 1994; Bouchard & Rankinen 2001). However, Active Australia currently recommends at least 30 minutes of moderate-intensity physical activity on most days, increasing the amount of movement in everyday activities, and regular, vigorous exercise (http://www.activeaustralia.org/facts/).

It has been suggested that the greatest population health benefits would come from getting the most sedentary members of the population to engage in some physical activity rather than trying to increase the physical activity levels of those who are already active (Blair & Connelly 1996).

Indirect physical health benefits may also be attributable to physical activity. For example, the introduction of swimming pools into remote Indigenous communities (together with safety precautions such as adequate supervision and proper water maintenance) appears to have reduced ear and skin infections in children (Lehmann et al. 2002; Lyford 2001).

Mental health/psychological wellbeing

There is considerable research to support the claim that physical activity reduces certain types of anxiety and depression and increases self-esteem and self-efficacy (Craig et al. 1994; US Department of Health and Human Services 1996; Collingwood et al. 2000; Fox 1999; Mason & Wilson 1988).

Depression is a risk factor for self-harm and suicide. Tatz (1999), however, cautions that suicides of Aboriginal people may not always be explainable by a ‘medical-psychiatric approach’. According to Tatz (1999, p.123), suicide is ‘motivated or occasioned by many things other than the personal family histories of suicide, aggressive behaviour, substance abuse, “depression”, and other mental illness’. There are suggestions from a study in prog- ress in Western Australia that impulsivity is more strongly correlated with suicide risk than depression in Aboriginal youth, and that cultural identity is a protective factor for suicide risk (Tracy Westerman, Indigenous Psychological Services, personal communication).