De- problematising Aboriginal young peoples’ health and well- being through their voice: An Indigenous scoping review

Background: The continued use of a deficit discourse when researching Aboriginal and Torres Strait Islander Peoples of Australia is problematic. Understanding and chal lenging the researchers position and the power of the words they use is important.


| INTRODUC TI ON
In 2019, a group of young Aboriginal Australian people wrote to the Prime Minister and his ministers asking them to challenge themselves to think differently about Aboriginal young people (Imagination Declaration-NRG). In doing so, it was their intention to end the current situation where Aboriginal Peoples are perceived as a problem; to overcome this issue, they asked him to think differently and see Aboriginal young people as the key to unlocking Aboriginal brilliances, leadership and imagination. By making their desire explicit, Aboriginal young people were making it known that they wanted to be heard, wanted to be tested and respected, and for us (government, policy writers, researchers) to expect the unexpected of them (Shay et al., 2019).
The purpose of this review is to understand Aboriginal young peoples' own experiences of health and well-being through their own voice. This goal has been achieved by the adoption of an Indigenous research approach to review the literature guided by Rigney's (1999) seminal work that articulated Indigenous research principles. Shay and Sarra's (2021)  Reflecting on the plethora of research conducted on Aboriginal young people and researchers' pursuit to understand their health and well-being issues (Azzopardi et al., 2013;Blair et al., 2005; Marmot, 2011), we recognised that the space is predominately dominated by western constructions of knowledge as has been previously acknowledged (Sherwood, 2010). As a result, the production of this knowledge continues the deficit narrative of what is known and what is to be known about Aboriginal young people, particularly from the position of what they lack or need (Blair et al., 2005;Marmot, 2011). These perspectives have been defined by Fogarty, Bulloch, et al. (2018), as a deficit discourse in action. Fogarty, Lovell, et al. (2018) further claim there is emerging evidence that the deficit discourse has had an impact on the health and well-being of Aboriginal people and their lives both in social and political contexts. This, they argue, is evident in the scholarly literature that has framed and represented Aboriginal identity and experience in a narrative of negativity, deficiency and failure. Fogarty, Lovell, et al. (2018) caution that they are not wanting to deflate the problems present in the realities of disadvantaged and socio-politico-economic experiences of Aboriginal people. Rather, they are concerned the deficit discourse narrative evident in policy and related discussions aimed at 'alleviating disadvantage' in fact operates as a tool for defamatory, patronising and race-based discourse (Bamblett et al., 2010;Doel-Mackaway, 2017, Fogarty, Bulloch, et al., 2018. Unfortunately, this deficit discourse has been used as a consequential reinforcement of the ongoing marginalisation of Aboriginal people and has rendered their voices, perspectives and worldviews silent (Bamblett et al., 2010;Fogarty, Bulloch, et al., 2018). These experiences and subsequent discourses have stemmed from the lasting impact of colonisation, particularly in countries that share similar colonial narratives such as countries in Canada, Australia, New Zealand and the United States (CANZUS) . Hyett et al. (2019) and Pitama et al. (2018) highlight in their respective countries that the 'creation' and persistence of the deficit discourse continues to be problematic for Indigenous people, where (often like Aboriginal people in Australia), individuals and communities are positioned as being responsible for the problems they experience, whilst there is a failure to recognise the wider socioeconomic and historical-political structures faced by indigenous peoples globally.
Recognising this, we began by critically reflecting on this perspective as we attempted to understand Aboriginal young peoples' well-being. To do so, we started to unpack the notion of health from K E Y W O R D S Aboriginal, adolescent, decolonising, First Nations, health and well-being, Indigenous, Social and emotional well-being, young people What does this paper contribute to the wider global clinical community?
• Aboriginal young people foster resilience and strength, of which can be strengthened and empowered by clinicians and service providers meaningfully embedding the principles of social and emotional well-being into their care.
• Due to the lasting impacts colonisation, disconnected Aboriginal young people recognised the collective need to connect or re-connect to culture, community and Elders, as a way of building strength and resilience holistically.
• Aboriginal young people experience oppression and marginalisation in systems in which we all engage. As clinicians, it is integral to consider the ways in which we can empower and promote Aboriginal young peoples' voices and rights to self-determination in health care.
Aboriginal peoples' perspectives, that encompassed the holistic view of body, mind and spirit. The guiding principles, highlighted by Gee et al. (2014), informed this discourse through the construction of the concept of Aboriginal social and emotional well-being. The principles are as follows: 1. Health as holistic 2. The right to self-determination 3. The need for cultural understanding 4. The impact of history in trauma and loss 5. Recognition of human rights 6. The impact of racism and stigma 7. Recognition of cultural diversity 8. Recognition of Aboriginal strengths. (Gee et al., 2014, p. 57).
By acknowledging this Aboriginal holistic paradigm of health, we as the authors, choose not to provide, you, the reader, a list of statistics, case studies and figures of Aboriginal young people's health and well-being from a deficit lens; instead, we engage with the work of Rigney (1999), where he offers a unique position of how Aboriginal people engage with research. Rigney (1999), in his Indigenous research agenda, articulated a legacy of racialised ideology that continues to reshape and construct knowledge about Aboriginal people. Rigney (1999) affirms that overcoming such racialised oppression will not be achieved by simply changing the attitudes and values of non-Aboriginal researchers, nor adding Aboriginal researchers into the space; he argues that Aboriginal people must be involved in defining, controlling and owning the Aboriginal epistemological and ontological experience articulated in research. By doing so, we collectively carry the potential to strengthen the opportunity for emancipation and liberation from oppression (Rigney, 1999). Rigney (1999) proposes his principles as a pathway forward to begin to construct the need for a unique epistemological and ontological way towards liberation. We have summarised Rigney's principles below: • Resistance-research is undertaken to articulate and be part of the struggle of Aboriginal people and recognise selfdetermination. It aims to support the personal, community, cultural and political struggles to heal from past oppressions towards the future; • Political integrity-Indigenist research is undertaken by Aboriginal people, we must set our own political agenda for liberation, which included being responsible to the community of focus; • Privileging indigenous voices in research is to be focus on the lives, historical experiences, ideas, traditions, aspirations, interests and struggles of Aboriginal people. Centering the research towards giving voice to Aboriginal people. (Rigney, 1999, p. 116) 2 | AIM Therefore, the aim of this review is to use an Indigenous approach to understand Aboriginal young people's health and well-being from their perspective. The following research question guided the review: From their perspective, how is Australian Aboriginal young people's health and wellbeing currently experienced?
The review protocol and the representation of the included studies are articulated through the critical reflection of these principles proposed by Rigney (1999). Importantly, it was further informed by a previous review Usher et al. (2021) that also used a reflective decolonising approach to scope Aboriginal young peoples' social and emotional well-being and resilience. That body of work began with the same challenges of being critically aware of the Westernised lens through which Aboriginal young people are viewed, understood and constructed in the scientific literature, the retrieved bodies of evidence all focused on the inadequacies and pit falls of Aboriginal young people rather than their strength, resilience and ability to bounce back. As highlighted by Fogarty, Lovell, et al. (2018), the decolonising process can be seen as both a regenerative concept that reinforces strength-based approaches and as a deliberate mechanism to move away from dominant deficit narratives in Aboriginal health research. By re-framing our approach through re-designing our research focus, we were able to peel away the layers of what was presented to us from the perspective of a deficit narrative others have warned about (Fforde et al., 2013;Fogarty, Bulloch, et al., 2018), and move towards incorporating literature that was holistic and strength focused in nature.

| Method
This research approach adopted an Indigenous-led worldview. This was informed by several Indigenous people, who have undertaken significant methodological work in this space, both for and with indigenous people globally. Enaction of this methodology started within the politically charted agenda, stated by Rigney (2003), informed by an Aboriginal worldview, which drew conscious attention to Aboriginal ways of knowing, being and doing and how we were able to reflect this in the findings using Indigenous narrative analysis (Kovach, 2010;Martin, 2008). Every stage of the review process (search, inclusion/exclusion, extraction, interpretation, findings) was guided by local Aboriginal peoples, both academic and nonacademic. The chosen inclusion and exclusion criteria are reflective of this process of engagement including the use of the social and emotional well-being principles (Gee et al., 2014) (See Table 1). To further ensure a systematic approach, we have reported our process against the PRISMA-ScR guidelines (See Supporting Information 1).
The chosen search strategy (displayed in Table 2) was developed from Usher's et al's (2021) method, with assistance from two research health librarians. This was to ensure no studies were missed in the review. When the final studies were extracted by RS and JD, a summary and characteristics table was used (See Table 3 Given this approach, all original studies included in the full-text screen were considered if they had community members or service provider voices alongside young people's voices; studies were removed if they spoke on behalf of Aboriginal young people (Shay & Sarra, 2021). Furthermore, we excluded studies that used comparative methods where Aboriginal people and conditions/behaviours such as substance abuse, chronic health conditions and mental health issues were compared against those of non-Aboriginal populations. Comparative studies reviewed predominately occurred through positivist research approaches that were excluded in the title and abstract screen. The importance of a decolonising approach to the literature was also crucial when reviewing texts; therefore, studies that showed no engagement with or by Aboriginal people were excluded. In addition, literature that did not articulate evidence of Aboriginal authorship, community engagement strategies or acknowledgement of positioning of non-Aboriginal researchers with/ in community were excluded from the review. Only Australian studies were considered.
Importantly throughout the process of engagement with the texts, we needed to ensure we did not apply blanket understandings across the diverse Aboriginal populations of Australia. To do this, we were guided by the local Aboriginal people involved in the project, by so doing, we demonstrated respect for their cultural safety and security throughout the review process. Uncle Neville Sampson, the Chair of the local Cultural Advisory committee, brought forward this review to the committee to ensure the inclusion of studies, analysis and findings were reflective of the cultural guidance given throughout the preparation of the paper. The robust committee discussion with both community members, peers and supervisors ensured the review was constructed from a decolonising position and that an Indigenous research approach was used, and a subsequent strength-based Indigenous narrative analysis resulted. Additionally, included studies Indigenous OR Native OR Aborigin* OR "Pacific Islander*" OR "Torres Strait Islander*" OR "First Nation*" Australia* resilien* OR "mental health" OR wellness OR "well-being" OR "well being" OR wellbeing OR strengths OR psychosocial OR "protective factor*" OR "coping behaviour*" OR "coping behavior*" OR growth OR emotion* OR value* OR health OR "physical health" We recognised that if we found any studies written in Indigenous language, the process would require seeking advice and translation of these studies. In the end, no such studies were located.

| Search strategy
The search strategy included both a comprehensive search of the literature using search terms within library databases (CINAHL, PsychINFO, ProQuest, Embase, Scopus, Informit, Medline and PubMed) and included search terms (See Table 2

| Study selection and outcome
All identified citations were collated and uploaded to EndNote X9 (2020), and duplicates removed. Titles were screened by two independent reviewers RS and JD; this process was undertaken to ensure that each study included matched the outlined inclusion criteria. After full-text screening, the team met and discussed the final studies against the inclusion criteria.
The search yielded a total of 4295 citations; this included studies retrieved from full-text review of reference lists. Using Endnote, several citations (4242) were excluded using key title/abstract search terms such as risk-based study titles (smoking, sexual health, diabetes), and perspectives of health workers/service providers, comparative studies and study types that were either reviews or quantitative study types. After this phase, a total of 53 articles remained for fulltext screening for inclusion, of which a total of 38 citations were excluded as predominately they were not focused on the perspective of young Aboriginal peoples' voices or their voices on health and wellbeing, including the voices of others on the issues of Aboriginal young peoples without the young people's perspectives/voices. After full review and at data extraction, a further 8 citations were removed due to topic focus outside of health and well-being. A total of 7 studies were finally included in the current review. Included studies with characteristics and contexts are included in Table 3. A flow chart detailing this process is included in Figure 1

| Types of sources
The review considered all study types that were qualitative or indigenous research paradigm in nature.

TA B L E 3 (Continued)
Grey literature in this context, is studies that were conducted outside of formal scholarly or peer-reviewed publication processes, these include studies that were conducted on behalf of agencies such as health and government organisations (Shrivastava & Mahajan, 2021).
One grey literature report was included which was produced as an external research activity on behalf of an organisation, thus limiting organisational bias. All the included seven studies were qualitative in nature, primarily using either interviewing (individual/focus groups) or yarning as their method of data collection. The total number of Aboriginal young people in the total studies were 228, aged between 11 years and 28 years, with a mean age of 19.5 years. Studies were from various locations in Australia, including urban, regional and remote locations. None of the quantitative studies, systematic reviews, texts or opinion articles met the inclusion criteria. Studies published in English since 1990 were reviewed to ensure a comprehensive contemporary analysis of all relevant literature was included.

| Interpretation of the data
The interpretation of the data has been informed using an indigenous analysis, which has been developed using Rigney's (2003) Indigenous research principles as a foundational layer in the methodology. This enabled the researchers to move through the interpretation as a F I G U R E 1 PRISMA 2020 flow diagram concept of 'self-in-relation' to the research data (Kovach, 2010, p. 14), where we learn in relationship to others, through a process of knowing and critical reflexivity (Nicholls, 2009). Adopting this approach allows space within the methodology to move beyond the confines of the mainstream research process to a deeper place of sense making within the context of the narrative (Kovach, 2010;Nicholls, 2009). This was enhanced by the two Aboriginal people on the review (RS and NS), who were continually guided by yarns with Aboriginal people from the local Aboriginal Cultural Advisory Committee and community members. In that way, the methodology was reinforced from an ethical starting place and positioned as a practice of respect and reciprocity in the community of relevance (Kovach, 2010). 'Strong Black man? I don't know … I reckon somebody, like… independent, takes care of his family, doesn't walk out on anyone in his life, somebody who works, has a job, takes care of his family and friends, and just represents his culture, and himself, in a good way and that, and yeah, just be pretty deadly' (Mukandi et al., 2019, p. 258).

| RE SULTS
As part of staying healthy, being independent and socially engaged, young people identified that it is a not a one-size fits all solution or a quick fix, but rather it involves ongoing maintenance of health (body, mind, spirit), for example, exercising, having a healthy diet, and positive experiences with positive people, and being supported from both individual and external factors (Jalla, 2016). This was seen by young people as having a holistic view of health and well-being that challenges the notion of health as not just being the absence of ill-health, but as seen within a broader lens of social and emotional well-being context. When young people accessed social and emotional well-being services, they reported that services that treated them holistically were crucial to the overall effectiveness of the service and the subsequent treatments received (Garay, 2021). Often central to the idea of seeing oneself through a holistic lens and receiving help, was the understanding of being supported to maintain all components of the body, mind, and spirit (Jalla, 2016).
Understanding support in the studies was seen at various stages in these young people's lives; support was not only experienced from young people's families or friends, but it was also extended to people around them like Elders, health professionals, justice workers, teachers and at times (Cerreto, 2018) whoever was there to listen and offer support (Mohajer et al., 2009). Importantly, when understanding these stories of support, they were interspersed with stories of feeling being respected, building trust and feeling heard In this articulation of the need to be heard and listened to, young people also recognised they may never be heard in the spaces of which they (are forced to) engage: 'They didn't know my story and they didn't ask. What did they think would change? My life was the same, I was the same, my stupid crimes were the same' (Cerreto,

2018, p. 27).
Within this experience of powerlessness through the telling of adversity, notions of giving up and through the scene setting of their context, the participants articulated stories of generational crime, poverty and grief (Cerreto, 2018). They also spoke of the stories of the negative experiences of racism, not belonging, substance abuse and being stereotyped; these experiences were framed by how the young people made sense of their adversity in relationship to the 1 Deadly is an adopted Aboriginal English word in Australia, as a word that means excellent, amazing, awesome or really good.
world around them (Cerreto, 2018;Garay, 2021;Mohajer et al., 2009;. Whilst at first glance, this quote frames this young person in a narrative of trauma or from a deficit discourse explained earlier in this paper as a tension, what is evident is that young people, despite trauma and being in trouble from birth, can still draw upon their deep connection to family, blood and kinship systems as a strength through one's affinity to family, 'I've been in trouble since before I was born. It's in my blood, my family…we were stuck…I learnt how to fend for myself ' (Cerreto, 2018, p. 16). Building strength by positioning oneself outside of the discourse, challenging and resisting authority as a way to build hope, offers a counter narrative from an Indigenous perspective.
Consequently, these events described by the participants were storied with the pervasiveness of racism and all its manifestations in their lives; often occurring in places like school, including experiences of physical, verbal and emotional attacks (Cerreto, 2018).
Subsequently, these young people were then labelled as the 'troubled one' or 'no hoper' stereotype, where the expectation from others is to fail. Ultimately, these stereotyped labels are internalised by the young person who may then begin to 'act out' as a way to overcome the hopeless situation they are exposed to (Cerreto, 2018,  In understanding these narratives, young people often told stories of running from these low expectations and experiences of shame and racism; they speak of stories of finding places to belong. Young people identified through this practice and engagement of their culture, that connection occurred across several anchor points (Jalla, 2016, Cerreto, 2018, Mukandi et al., 2019. Where they experienced Connection to.
Connection to Elders and knowledge holders was expressed and experienced in various spaces. Young people see that for their social and emotional well-being, they must connect, stay connected and re-connect with Elders and knowledge holders, as people who are able to help them and guide them through their life 'being able to talk and sit around a campfire and just yarn' (Garay, 2021, p. 81). This practice was identified as something that assists them spiritually and culturally (Garay, 2021). How did you know that? I was smiling and laughing all day," and then she goes, "you don't understand babe, we're connected, I can feel every time, I can feel your heart break. . . I felt that" (Murrup-Stewart et al.,

2021, p. 6)'.
Connection is experienced through the young people engaging with Country. This is across various spaces with various experiences.
Similar to connecting with Elders, young people connected with Country as a way of spiritual healing, where they can sit, reflect and acknowledge and recognise the importance of connection to country (Cerreto, 2018;Jalla, 2016). The connection is experienced at certain times, or, throughout their everyday practice, such as crushing and smelling the eucalypt from a leaf (Murrup-Stewart et al., 2020). Other instances are mapping out times to engage with Country, and being safe on country, and to be present and to learn from Country .

| DISCUSS ION
The aim of this review was to understand Aboriginal young people's health and well-being from their perspective. Given the ongoing and significant advance of indigenous research and the ongoing methodological leadership and progression in this area, the need for deficit based, comparative, defamatory studies must be a thing of the past, considered as a part of Terra Nullius research era (Sherwood, 2010 (Gee et al., 2014;Hyett et al., 2019). What has been identified in other CANZUS indigenous populations is the need for the improvement and engagement with cultural relevant approaches to healthcare service delivery, that focuses not just on indigenous peoples issues, but nurses and clinicians receiving specific training to given proficient and culturally safe health care, that emphasises the need for clinicians to interrogate their own beliefs, values and privilege (Curtis et al., 2019;Wilson et al., 2021). Where the promotion of relational approaches is integral, with the need for delivery and interactions to be centred around cultural values, concepts and practices guided by/with family and community engagement throughout; to empower indigenous people to be self-efficient and self-determined whilst receiving culturally safe centred health care (Curtis et al., 2019;Wilson et al., 2021).
Understanding risk and the failings of the current systems, although framing young people from a deficit narrative, some of the perspectives of young people recognised the generational impact of being stuck and being part of the system prior to being born (Cerreto, 2018 (Salmon et al., 2018). This includes people reconnecting to culture as a way of navigating out of detention and the justice system, and recognising the need for ongoing connection throughout their lives (Cerreto, 2018). Further, they identified that culture is crucial to their overall well-being and spirituality. Despite such significant evidence, the study identified that culture was still only indirectly or infrequently mentioned in mental health services when caring for Aboriginal people by clinicians (Salmon et al., 2018). Historical trauma is a growing space in research, particularly in first how complex trauma is understood and further, how its impacts young Aboriginal peoples' health and well-being as part of their everyday experience in the modern world .
Furthermore, culture is a multi-facet concept that has varying, overlapping impacts on health and social and emotional well-being (Salmon et al., 2018). Historical trauma and its relationship with culture remains greatly understudied in the context of Aboriginal young peoples' health and well-being in Australia, despite being recognised as fundamental to social and emotional well-being principles (Gee et al., 2014). Particularly absent in the literature is the production of such knowledge and understanding of the importance that such research must be conducted by Aboriginal people, with Aboriginal people and their voices at the centre (Azzopardi et al., 2018, Salmon et al., 2018Smallwood et al., 2021).
Although we do not consider this a limitation, we purposefully only selected studies that had the presence of Aboriginal young people's voices, thus limiting the inclusion of a potentially wider range of studies. Further, the selection of only traditional peer-reviewed research studies limited research that may have been disseminated using non-traditional formats, such as art, audio-visual or oral methods.

| CON CLUS ION
This review was designed to understand young Aboriginal people's perspective of their health and well-being. Given literature reviews are the foundation of research that informs research, policy and practice, by using an indigenous approach and analysis, the review presents a strength-based counter narrative that highlights insights into the storied accounts of young people from their perspective and context. Identifying how young Aboriginal people foster strength and resilience, which is enhanced through meaningful recognition by the services they encounter, and by the adoption and meaningful embeddedness of the social and well-being principles of health (Gee et al., 2014). During the process of the review, an interconnected picture emerged about how Aboriginal young people enact agency in a highly racialised, often oppressive spaces, thereby expanding current understandings of the importance of culture, and the connectivity, relationality and dependability of culture. Although an absence of explicit text within studies about the impact of colonisation was revealed, understanding this through a social and emotional well-being view of health allowed young peoples' stories to reveal the enduring impact of colonisation and its impact on culture, country, community and kinship systems; arguably something that all Indigenous young people potentially face within the CANZUS nations. Furthermore, this review has illustrated how disconnected young people have experienced loss, but also how they can rebuild their cultural identity through connection to culture, country and Elders in order to forge a way towards resilience and strength holistically.

| RELE VAN CE TO CLINI C AL PR AC TI CE
Literature reviews are the foundation in which inform nursing practice. As clinicians, nurse-researchers and academics pursing research and policy development within the Aboriginal health and wellbeing space; a conscious awareness is required when engaging with this literature. What was identified by this review, most current literature is informed from a deficit discourse perspective. By shifting consciousness and awareness of these issues, clinicians, nurseresearchers, and academics can be informed through the emphasis of Aboriginal young peoples' voices, their strength and resilience in the health and wellbeing space.

ACK N OWLED G EM ENTS
We acknowledge the members of our Cultural Advisory Group who collaborate with us on all research activities. Further, we acknowledge the local Aboriginal women who met with the First Author to discuss how Aboriginal people position risk in the context of social and emotional well-being. We are forever grateful for all the support we receive along this research journey. We further acknowledge Dr.
Joanne Durkin for assisting with the screening, searching and appraising as the second reviewer on this review.

CO N FLI C T O F I NTE R E S T
The authors declare no conflict of interest.

DATA AVA I L A B I L I T Y S TAT E M E N T
Data sharing is not applicable to this article as no new data were created or analyzed in this study.