Becoming empowered: a grounded theory study of Aboriginal women's agency

Objective: The study aim was to identify the process underlying the performance of agency for urban-dwelling Aboriginal women in contemporary Australian society with a view to promoting social change for Aboriginal people. Method: Grounded theory methods were used in the conduct of 20 life history narrative interviews with Aboriginal women from across fourteen different language groups. Results: Analysis identified a specific ecological model of Aboriginal women's empowerment, defined as "becoming empowered". "Performing Aboriginality" was identified as the core category and encompassed the women's concern for carving out a fulfilling life and carrying out their perceived responsibilities as Aboriginal women. Conclusions: While confirming much of the extant literature on empowerment, the analysis also offered unique contributions – a spiritual sensibility, cultural competence and an ethics of care and morality. This sheds new light on the creative ways in which Aboriginal women "disrupt" discourses and create alternate modes of existence. The findings have implications for improving quality of life for Aboriginal people by informing the practical development and delivery of social and health policies and programs

Cultural competency in the delivery of health services for Indigenous people

Aim and objectives This review aims to examine available evidence on cultural competence in health care settings to identify key approaches and strategies that can contribute to improving the development and implementation of Indigenous health services and programs. The objectives are to: 1. define cultural competency –– we consider the significance of cultural competence and how it has been defined in international and local literature, including the use of similar terms and meanings 2. report on the quantity, nature and quality of available evidence –– we look at available evidence on cultural competency in Australia, New Zealand, Canada and the United States, including how cultural competence has been measured, and assess the quality of the evidence against basic methodological criteria 3. identify approaches and strategies that are effective in improving cultural competency among health services staff 4. examine the relationship between cultural competency and health outcomes 5. develop an evidence-informed conceptual framework of cultural competency

Changing discourses in Aboriginal and Torres Strait Islander health research, 1914-2014

Aboriginal and Torres Strait Islander people strongly assert that health research has contributed little to improving their health, in spite of its obvious potential. The health concerns of Aboriginal and Torres Strait Islander people were largely ignored in early research published in the MJA, which reflected broader colonial history and racial discourses. This began to change with the demise of scientific racism, and changed policies and political campaigns for equal treatment of Indigenous people after the Second World War. In response to pressure from Aboriginal and Torres Strait Islander people and organisations, in parallel to broader political struggles for Indigenous rights since the 1970s, there have been significant and measurable changes to Aboriginal and Torres Strait Islander health research. Many of these changes have been about the ethics of health research. Increasingly, Aboriginal and Torres Strait Islander researchers, communities and organisations are now controlling and decolonising health research to better meet their needs, in collaboration with non-Indigenous researchers and research organisations

Improving Indigenous Australian governance: the how and what of capacity strengthening

In this paper, capacity strengthening will be pragmatically explored in response to two key questions: what enabling approaches are accessible for Aboriginal and Torres Strait Islander Australian (hereafter Indigenous) organisations to effectively make governance decisions; and what approaches can facilitate partnership processes between communities and governments for improving Indigenous Australian organisational governance. In particular, it will consider 1) the need to strengthen both hard capacities such as resources, technical skills, functions, structures, equipment and so forth; and soft capacities such as values, morale, engagement, motivation, incentives and staff wellbeing; and 2) one strategy that has successfully been used to facilitate partnership between Indigenous organisations and governments - reflective participatory approaches. It will draw from reflective short case study examples in which the authors have participated to demonstrate how, where and when capacity strengthening principles have been adopted. Given the paucity of well-designed evaluations, key principles and practices that appear to work to strengthen capacity will be discussed. Key amongst these are community ownership of governance improvement, collaborative development approaches that are context-dependent and long-term partnerships between government agencies and Indigenous communities built on trust and respect. Capacity-strengthening must have a clear notion of what type of capacity is being strengthened, for whom, and how the effectiveness will be measured

The implementation and evaluation health promotion services and programs to improve cultural competency: a systematic scoping review

Background: Cultural competency is a multifaceted intervention approach which needs to be implemented at various levels of healthcare systems to improve quality of care for culturally and ethnically diverse populations. One level of healthcare where cultural competency is required is in the provision of health promotion services and programs targeted to diverse patient groups who experience healthcare and health inequalities. To inform the implementation and evaluation of health promotion programs and services to improve cultural competency, research must assess both intervention strategies and intervention outcomes. Methods: This scoping review was completed as part of a larger systematic literature search conducted on evaluations of cultural competence interventions in health care in Canada, the United States, Australia and New Zealand. Seventeen peer-reviewed databases, 13 websites and clearinghouses, and 11 literature reviews were searched. Overall, 64 studies on cultural competency interventions were found, with 22 being health promotion programs and services. A process of thematic analysis was utilized to identify key intervention strategies and outcomes reported in the literature. Results: The review identified three overarching strategies utilised in health promotion services and programs to improve cultural competency: community focused strategies, culturally focused strategies, and language focused strategies. Studies took different approaches to delivering culturally competent health interventions; with the majority incorporating multiple strategies from each overarching category. There were various intermediate healthcare and health outcomes reported across the included studies. Most commonly reported were positive reports of patient satisfaction, patient/participant service access and program/study retention rates. The health outcome results indicate positive potential of health promotion services and programs to improve cultural competency to impact cardiovascular disease and mental health outcomes. However, due to measurement and study quality issues, it is difficult to determine the extent of the impacts. Discussion: Examined together, these intervention strategies and outcomes provide a framework which can be used by service providers and researchers in the implementation and evaluation of health promotion services and programs to improve cultural competency. While there is evidence indicating the effectiveness of such health promotion interventions in improving intermediate and health outcomes, further attention is needed to issues of measurement and study quality

Evaluating and Measuring Aboriginal and Torres Strait Islander Maternal and Infant Health Programs: a literature review for the Apunipima Baby Basket evaluation

The underutilisation of maternal and infant health (MIH) care services by Aboriginal and Torres Strait Islander women, along with the lack of appropriate, culturally safe care, has been a driving factor behind creating Aboriginal and Torres Strait Islander MIH care programs such as the Baby Basket (BB) program. High quality evaluations of MIH programs are necessary for quality, evidence-based care. This literature review has been conducted to inform the evaluation design and ongoing quality improvement of the BB program. The review summarises previously used evaluation designs and available indicators for evaluating and monitoring Aboriginal and Torres Strait Islander MIH programs. An outline of the issues associated with these types of evaluation designs and indicators is provided, along with suggestions for improving data collection and evaluation quality

Aboriginal and Torres Strait Islander maternal and child health and wellbeing: a systematic search of programs and services in Australian primary health care settings

Background: Persistent disparities in pregnancy and birth outcomes between Aboriginal and Torres Strait Islander and other Australians evidence a need to prioritise responsive practice in Maternal Child Health (MCH). This study reviewed the existing knowledge output on Aboriginal and Torres Strait Islander MCH programs and services with the objective to advance understanding of the current evidence base and inform MCH service development, including the identification of new research priorities. Methods: A systematic search of the electronic databases Informit, Proquest, PubMed, Scopus, Wiley, and Cinahl, and 9 relevant websites was undertaken for the period 1993-2012. The reference lists of MCH program reviews were hand-searched for additional relevant studies which met the eligibility criteria. The study designs of included publications were classified and the characteristics extracted and categorized. Evaluation quality was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies and the Critical Appraisal Skills Program (CASP) tool for qualitative studies. Results: Twenty-three search results were identified for inclusion, with the majority published in 2003-2012. Fifty two percent of publications reported on programs and services operating out of Aboriginal Community Controlled Health Organisations, with antenatal and postnatal care the main intervention type/s, and health promotion/education and advice/support the most common intervention component. Outcomes such as increased antenatal attendance and higher infant birth weights were reported in some intervention studies, however methodological quality varied considerably with quantitative studies typically rated weak. Conclusion: The prevalence of community controlled and/or community-based programs is significant given the health and wellbeing implications of self-determination. While the literature highlights the promise of many intervention models and program components used there are some significant gaps in the documentation and implementation of important MCH interventions. Similarly, while positive health outcomes were reported there are issues with key measures used and study quality. This review highlights the need to improve the quality of evaluations of MCH programs for Aboriginal and Torres Strait Islander women and to address the key evidence gaps in responding to their health and wellbeing needs

Staff Capacity Development Initiatives That Support the Well-being of Indigenous Children in Their Transitions to Boarding Schools: A Systematic Scoping Review

Background: Secondary education for Indigenous children from remote communities requires separation from their communities and families. As these students transition to boarding schools, they face several challenges that are additional to those faced by their non-Indigenous peers. In response, adequate academic and emotional well-being support needs to be provided by school and residential staff. This systematic review reports on international and Australian capacity development initiatives for education and boarding staff that support these students. \ud Methods: Five databases were searched using database-specific search strings, considering peer-reviewed articles and gray literature, published between 2001 and 2016. The resultant publications were screened to identify (a) their nature and quality and (b) their characteristics in terms of aims, strategies, and outputs. \ud Results: Seven hundred thirty-six citations were identified; 51 full text publications met inclusion criteria for assessment. Seven publications were eligible for review. Staff capacity building initiatives encompassed a range of approaches, including training, feedback, reflective practice, mentoring, networking, and supervision. Only one publication focused specifically on the support of education staff, others were centred on improving educational, behavioral, and emotional outcomes for Indigenous boarding school students. All of the research was descriptive, with only two original research publications. \ud Conclusion: Despite a variety of approaches being described in brief, we found no high quality research that focused exclusively on staff capacity building approaches in the Indigenous boarding school context. The few publications available to review were exclusively descriptive in nature, highlighting a clear need for well-executed evaluation research

Community first responders: a missing key to reducing disability and death in low and middle income countries in the Western Pacific?

This perspective article discusses the potential role community first responders could play in reducing death and disability in low- and middle-income countries in the Western Pacific. Community first responders are reportedly making a difference in low- and middle-income countries in Asia and Africa in reducing death and disability, and disease surveillance and reporting. Efforts must be made to explore the appropriate and effective introduction of locally tailored community first responder programs in the Western Pacific

Family-centred interventions by primary healthcare services for Indigenous early childhood wellbeing in Australia, Canada, New Zealand and the United States: a systematic scoping review

Background: Primary healthcare services in Australia, Canada, New Zealand and the United States have embraced the concept of family-centred care as a promising approach to supporting and caring for the health of young Indigenous children and their families. This scoping review assesses the quality of the evidence base and identifies the published literature on family- centred interventions for Indigenous early childhood wellbeing. Methods: Fourteen electronic databases, grey literature sources and the reference lists of Indigenous maternal and child health reviews were searched to identify relevant publications from 2000 to 2015. Studies were included if the intervention was: 1) focussed on Indigenous children aged from conception to 5 years from the abovementioned countries; 2) led by a primary healthcare service; 3) described or evaluated; and 4) scored greater than 50% against a validated scale for family-centredness. The study characteristics were extracted and quality rated. Reported aims, strategies, enablers and outcomes of family-centredcare were identified using grounded theory methods. Results: Eighteen studies (reported in 25 publications) were included. Three were randomised controlled studies; most were qualitative and exploratory in design. More than half of the publications were published from 2012 to 2015. The overarching aim of interventions was to promote healthy families. Six key strategies were to: support family behaviours and self- care, increase maternal knowledge, strengthen links with the clinic, build the Indigenous workforce, promote cultural/ community connectedness and advocate for social determinants of health. Four enablers were: competent and compassionate program deliverers, flexibility of access, continuity and integration of healthcare, and culturally supportive care. Health outcomes were reported for Indigenous children (nutritional status; emotional/behavioural; and prevention of injury and illness); parents/caregivers (depression and substance abuse; and parenting knowledge, confidence and skills); health services (satisfaction; access, utilization and cost) and community/cultural revitalisation. Discussion and conclusion: The evidence for family-centred interventions is in the early stages of development, but suggests promise for generating diverse healthcare outcomes for Indigenous children and their parents/caregivers, as well as satisfaction with and utilisation of healthcare, and community/cultural revitalisation. Further research pertaining to the role of fathers in family-centred care, and the effects and costs of interventions is needed