Introduction

The Indigenous people of Australia comprise two groups: Aboriginal Australians and Torres Strait Islanders, approximately 3.3% of the total Australian population.1 Aboriginal and Torres Strait Islander Australians have experienced intergenerational trauma related to colonization and subsequent dispossession, poor treatment, exploitation and cultural fragmentation over the past 200 years, consistent with other Indigenous groups worldwide.2 This has led to health and social inequalities, such as gaps in life expectancy, education and employment.1 A strengths-based approach that draws on positive aspects of Aboriginal and Torres Strait Islander culture and resources is considered the most effective way to reduce disparities.3

The benefits of promoting physical activity for health are well established.4 Physical activity can be particularly beneficial for groups with increased rates of chronic disease and higher levels of risk factors for chronic disease, including Indigenous populations worldwide.1,5 Traditional active hunter-gatherer lifestyles of Aboriginal and Torres Strait Islander people that had existed for tens of thousands of years were forever disrupted by the dispossession associated with colonization, but traditional activities and games can still hold cultural relevance and benefit.1 Systematic reviews have demonstrated the positive impact of physical activity interventions on a range of physical health indicators among Aboriginal and Torres Strait Islander Australians. However, these reviews have typically only examined markers of an individual's health, such as reduced weight and blood pressure, improved fitness, and biomarkers, such as blood glucose.6,7

Beyond individual physical health outcomes, there is support for the positive impact of physical activity on wider social outcomes, social and emotional wellbeing (SEWB) and mental health.8 Evidence from studies conducted in non-Indigenous populations have found that physical activity participation can achieve broader social benefits through education attainment9 and crime prevention.10 An examination of 18 previous reviews on physical activity and mental health in children and adolescents found some association between physical activity participation and aspects of mental health in young people, including lower levels of anxiety and depression and improved self-esteem.11 However, research designs were often found to be weak and effects were small to moderate. Among adults, there is a bidirectional relationship between physical activity and depression; depression leads to subsequent reduced rates of physical activity,12 and physical activity reduces the risk of future depression.13 Emerging cross-sectional international evidence has demonstrated positive associations between physical inactivity and anxiety,14 and physical activity and happiness.15 Given a more holistic focus on the importance of family and community among Aboriginal and Torres Strait Islander people, social and mental health outcomes derived from physical activity may hold more relevance than measures of an individual's health.16 While concepts of SEWB and mental health are difficult to define from an Aboriginal and Torres Strait Islander perspective, a framework has been developed that places Indigenous views and culture as central to key domains and principles.3 Overall, there is a lack of empirical evidence for the benefits of physical activity for broader social outcomes among Aboriginal and Torres Strait Islander people.

Sport is a key subclass of physical activity.17 Programs encouraging sport participation have been a recommended means of improving social outcomes since the Royal Commission into Aboriginal Deaths in Custody in the late 1980 s.18 There have been documented examples in the literature of great sporting prowess by Aboriginal and Torres Strait Islander athletes at the elite level in sports, such as the Australian Football League19 and athletics.20 There have also been attempts to extrapolate these achievements of individuals to apply to all Aboriginal and Torres Strait Islander people, and sport has been promoted as a broad panacea for a number of social issues, such as anti-social behavior and educational outcomes.21 A 2013 parliamentary report highlighted the potential of sport as a tool for "closing the gap" between non-Indigenous and Indigenous Australians on a wide range of health and social outcomes, but it noted a paucity of evidence to support current claims and investment in sport programs.22

A narrative review of 110 physical activity and sport programs for Aboriginal and Torres Strait Islander people found that almost one-third were aimed at achieving broader social benefits, such as educational and employment outcomes and reduced rates of crime.8 In the absence of empirical evidence, a cautious approach should be taken to alluding to wider social benefits directly arising from individual programs; however, several programs were described using outcome data from primary studies identified within the peer-reviewed literature. These included studies examining outcomes relating to education, employment, culture, SEWB, life skills and crime prevention. Therefore, the focus in the present review will be on these six outcomes a priori.

A preliminary search of the Cochrane Library, MEDLINE, Scopus, SPORTSDiscus, PsycINFO and Informit databases has been undertaken, and no existing reviews or scoping reviews on the topic were found. A scoping review on this topic would synthesize the existing literature to provide insight into specific areas where further development of the evidence could be beneficial and to guide future physical activity and sport programs to address social outcomes for Aboriginal and Torres Strait Islander adults and children. We aim to conduct a systematic scoping review of the evidence on the impact of physical activity and/or sport programs on one (or more) of the following six broader social outcomes among this population: education, employment, culture, wellbeing (including SEWB and other relevant aspects of mental health), life skills and crime prevention. The findings will provide direction for future sport and physical activity initiatives for Indigenous people, both in Australia and internationally, to achieve positive outcomes beyond individual health.

Review objectives

The objective of this scoping review is to identify and describe existing research on the impact of sport and physical activity programs on social outcomes among Aboriginal and Torres Strait Islander people in Australia. Social outcomes are categorized as six main measures relating to education, employment, culture, social and emotional wellbeing, life skills and crime prevention.

Inclusion criteria

Participants

This review will consider studies that include Aboriginal and Torres Strait Islander people living in Australia, as identified in the relevant study. Studies that include participants of other ethnicities will be considered if the majority of participants are Aboriginal and Torres Strait Islander people or if results for Aboriginal and Torres Strait Islander participants are provided separately. There is no exclusion criteria based on participant age.

Concept

This review will consider studies that report on programs or activities that use physical activity and sport participation as a component or tool to improve one or more of six social and community outcomes8: education, employment, culture, social wellbeing, life skills and crime prevention. There are no exclusion criteria based on the length or frequency of the program or activity, but one-off events will be excluded due to the short nature of their delivery.

Context

Activities and programs delivered in all regions of Australia (urban, rural and remote) and in any setting (e.g. schools, workplaces, community centers) will be considered for inclusion if participants continue to live in their usual environment, including residential school settings.

Types of studies

All qualitative, quantitative, economic and mixed methods studies will be considered for inclusion. In addition, reviews with programs that meet the inclusion criteria will also be retrieved to examine relevant individual studies. Policy studies and expert opinion will not be included as they do not report the results of original, empirical investigation.

Methods

This review will use an established methodology for scoping reviews from the Joanna Briggs Institute.23

Search strategy

Consultation with a health research librarian assisted in the selection of nine relevant electronic databases: MEDLINE, Scopus, SPORTSDiscus, PsycINFO, Informit, the Database of Abstracts of Reviews of Effects (DARE), the Cochrane Library, the Campbell Library, and ProQuest Dissertations and Theses. The first step will be an initial limited search of a selection of these databases, followed by an analysis of text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference lists of all identified reports and articles will be searched for additional studies. The search will not be limited by date and will go back as far as the databases allow. Studies will be limited to those published in English.

Initial search terms will include Indigenous, Aboriginal, Torres Strait Islander, physical activity, sport, fitness, exercise, academic, education, employment, school, life skills, crime, social, psycho-social, wellbeing, mental health, self-esteem, culture and community. Search terms will be combined using Boolean logic with the use of truncation and wildcards. A location filter for Australia will be applied where available. A full search strategy for Scopus is provided in Appendix I.

To capture additional gray literature eligible for inclusion, a search of relevant websites that provide information, links and resources related to physical activity, sport and social outcomes for Aboriginal and Torres Strait Islander will also be conducted. The search strategy across websites will be modified as required. The sites to be initially searched are Australian Indigenous HealthInfoNet, Australian Institute of Aboriginal and Torres Strait Islander Studies, Australian Institute of Criminology, Australian Institute of Family Studies, Australian Institute of Health and Welfare, Australian Physical Activity Network, Australian Sports Commission, the Lowitja Institute (Australia's National Institute for Aboriginal and Torres Strait Islander Health Research), ACT Government Sport and Recreation, Northern Territory Government Sport and Recreation, NSW Government Office of Sport, Queensland Government Department of Housing and Public Works (Sport and Recreation), Government of South Australia-Office for Recreation and Sport, Tasmanian Government Department of Premier and Cabinet (Sport and Recreation), Sport and Recreation Victoria, Government of Western Australia Department of Local Government, and Sport and Cultural Industries.

Study selection

All identified citations will be collated and uploaded into EndNote (Clarivate Analytics, PA, USA), and duplicates will be removed. Articles will be assessed based on the previously mentioned inclusion criteria, examining them by title and abstract. Full text of the articles will be retrieved if they meet the inclusion criteria or if further examination is required to determine the eligibility of the study. Study authors will be contacted if further clarification is required. Two reviewers will independently confirm if the full-text article meets the inclusion criteria. Any disagreements will be resolved by a third reviewer. The results of the search strategy will be presented in a PRISMA flow diagram24 indicating the number of articles found via each search method and the articles excluded. A list of articles excluded at full text will be available, including the main reason the article was excluded.

Data extraction

The relevant content from each study will be extracted using data extraction tool. The majority of the data extraction (75% of studies) will be conducted by one reviewer and cross-checked by a second reviewer, with the remaining studies extracted by the second reviewer and cross-checked by the first reviewer. Data extracted will include author(s), year of publication, year(s) of program/activity, aims/objectives, program setting, design, participant inclusion criteria (age, sex), main outcomes measured and a brief description of the program (Appendix II). If more than one paper is found for a study or project, they will be treated as one for data extraction. If a review describes multiple health promotion programs, those that meet the inclusion criteria will be included if their results are reported separately.

Presentation of findings

Study characteristics from the data extraction will be presented in a table with accompanying narrative. The characteristics reported will include citation, study aim, design and methodology, social outcome(s), outcome measures, setting details, participant details and program description, including organizations involved in program delivery. There will be a record of the details of capacity building among local Aboriginal and Torres Strait Islander people through the program and also any Indigenous researchers involved, if they are identified.

Acknowledgments

We would like to thank Jessica Hughes for her assistance in the development of the review strategy and search terms.

Funding

This scoping review is supported by an Australian Research Council grant IN160100035.

Appendix I: Search strategy for Scopus

indigenous OR aborigin^* OR "Torres Strait"

AND

"physical activity" OR sport

AND

education OR employ^* OR crime OR "life skills" OR social OR self OR mental OR cultur^* OR wellbeing

Appendix II: Physical activity and social outcomes data extraction instrument

References