Increasing community participation in an Aboriginal health service

Objective: To increase Aboriginal participation with mainstream health professionals in an Aboriginal health and well‐being centre. Design: Participatory Action Research using Aboriginal traditional symbolism to depict aspects of the research process, interview surveys and a document review. Setting: A regional town with 629 Aboriginal and Torres Strait Islander residents and a newly established Aboriginal health and well‐being centre (Nunyara). Participants: Thirty Aboriginal community members were interviewed about their involvement with Nunyara and their health issues. Participants were selected through purposive ‘pass‐me‐around’ sampling to ensure that all family groups were included. Results: The results are presented in two areas: the structure of the Aboriginal community that affects participation and community views about health issues. Aboriginal people living in the town come from 10 or more different language groups and relate almost exclusively within their own groups. Activities at Nunyara were seen as individual family group events and not for everyone. Aboriginal community participants had a broad view of health as they reported problems that included smoking and alcohol use. Almost all would like more involvement in health issues through Nunyara. Conclusion: Aboriginal community members are willing to get involved in health issues in collaboration with Nunyara. However, fundamental to increasing participation is to bring people together from different family groups and increase social cohesion. This can be done through developing relationships with groups enabling different points of view to be heard and valued.     

Protective services teams: the social worker as liaison

Multidisciplinary teams are widely used in response to complex problems such as child abuse, but they involve areas of potential conflict. Using his experience as a public agency liaison to the protective services team of a major children's hospital, the author examines how the liaison role combined with social work skills can help reduce conflict and enhance the performance of such teams.     

The Gudaga Study: establishing an Aboriginal birth cohort in an urban community

Objective: This paper describes the establishment of the Gudaga Study, an Aboriginal birth cohort in south‐west Sydney, and our approach to follow‐up of participants. The Study describes the health, development, and services use of Aboriginal infants and their mothers. The research team works closely with the local Aboriginal community to implement the research. Methods: All mothers in the maternity ward of an urban hospital were surveyed to identify mothers with an Aboriginal infant. These and some additional mothers identified through other networks were recruited to the study. Results: The number of mothers were surveyed was 2,108. Mothers of Aboriginal infants were younger (25.3 years compared to 28.4 years, p<0.001), less likely to be married (16.1% cf. 58.4%, p<0.001) and to have completed school (63.2% cf. 77.8%, p=0.002) than mothers of non‐Aboriginal infants. Of 155 identified mothers of Aboriginal infants, 136 were recruited and 23 through other networks. At 12 months, 85.5% of infants were followed up. Conclusions: This study, to our knowledge, is the first cohort study of this kind on the eastern seaboard of Australia. The study has strong community support and follow‐up, contrary to views that Aboriginal people are reluctant to participate in research. These data have national and regional significance.     

Perspectives on childhood resilience among the Aboriginal community: an interview study

Objective : To describe Aboriginal community members' perspectives on the outcomes and origins of resilience among Aboriginal children. Methods : Face‐to‐face interviews were conducted with 36 Aboriginal adults (15 health service professionals, 8 youth workers and 13 community members) at two urban and one regional Aboriginal Community Controlled Health Service in New South Wales. Interviews were transcribed and analysed thematically. Results : We identified six themes: withstanding risk (displaying normative development, possessing inner fortitude); adapting to adversity (necessary endurance, masking inner vulnerabilities); positive social influences (secure family environments, role modelling healthy behaviours and relationships); instilling cultural identity (investing in Aboriginal knowledge, building a strong cultural self‐concept); community safeguards (offering strategic sustainable services, holistic support, shared responsibility, providing enriching opportunities); and personal empowerment (awareness of positive pathways, developing self‐respect, fostering positive decision making). Conclusions : Community members believed that resilient Aboriginal children possessed knowledge and self‐belief that encouraged positive decision making despite challenging circumstances. A strong sense of cultural identity and safe, stable and supportive family environments were thought to promote resilient behaviours. Implications for public health : Many Aboriginal children continue to face significant adversity. More sustainable, Aboriginal‐led programs are needed to augment positive family dynamics, identify at‐risk children and provide safeguards during periods of familial adversity.     

Survival tucker: improved diet and health indicators in an Aboriginal community

Abstract: The poor nutritional status of Aboriginal Australians is a serious and complex public health concern. We describe an unusually successful health and nutrition project initiated by the people of Minjilang, which was developed, implemented and evaluated with the community. Apparent community dietary intake, assessed by the ‘store-turnover’ method, and biochemical, anthropometric and haematological indicators of health and nutritional status were measured before intervention and at three-monthly intervals during the intervention year. Following intervention, there was a significant decrease in dietary intake of sugar and saturated fat, an increase in micronutrient density, corresponding improvements in biochemical indices (for example, a 12 per cent decrease in mean serum cholesterol, increases in serum and red cell folate, serum vitamin B₆ and plasma ascorbic acid), decrease in mean systolic and diastolic blood pressures, a normalisation of body mass index, and a normalisation of haematologic indices. The success of this project demonstrates that Aboriginal communities can bring about improvements in their generally poor nutritional status, and that the store-turnover method provides a valid, inexpensive and noninvasive method for evaluating the resultant changes in community diet. Although the project was undoubtedly effective in the short term, further work is in progress to assess individual strategies with respect to sustainability, cost-effectiveness and generalisability.     

Diarrhoeal disease: Knowledge,attitudes and practices in an Aboriginal community

This study was carried out in an Australian Aboriginal community in South Australia on the knowledge, attitudes and practices relating to diarrhoea] disease. Suggestions were sought on appropriate interventions. Dietary causes (including alcohol), factors relating to drinking water, poor environmental hygiene, infective agents and teething were considered by community member to be important in the causation of diarrhoea. Poor personal and domestic hygiene, and the lack of adequate bathing, toilet and laundry facilities were not considered to be important contributory factors. This may reflect the Aboriginal view of hygiene derived from many years of desert living as nomadic hunter-gatherers. The study provides valuable information to enable the selection of appropriate interventions for the control of diarrhoeal disease in this community.     

Legitimizing diabetes as a community health issue: a case analysis of an Aboriginal community in Canada

The Kahnawake Schools Diabetes Prevention Project (KSDPP) is an ongoing participatory research and intervention project aimed at the primary prevention of type 2 diabetes. Formally initiated in 1994 with strong community support, KSDPP provides a fertile opportunity to learn about how a community came to identify the need for preventive action on a health problem such as diabetes. The purpose of our study was to describe the various conditions in the community of Kahnawake, which gave rise to its mobilization for the prevention of type 2 diabetes. Qualitative data consisted of 12 individual interviews and one focus group with key community members and health professionals living and/or working in the community of Kahnawake, along with historically relevant documents. The data collection and analysis procedures of the grounded theory method were applied. Results describe a preceding phase to formal KSDPP implementation, triggered by returning research results on the community prevalence of type 2 diabetes. This phase of 'legitimizing diabetes as a community health issue' is characterized by a shift in the perceived preventability of diabetes among community members; from a problem that was to be lived with to a problem that was to be prevented. The shift in perceptions was facilitated by the context in the community, described by structural developments, cognitive and relational elements. In addition to reaffirming the critical importance of utilizing lay knowledge during the planning of a health promotion intervention, our study has uncovered some of the key conditions through which individuals in the community came to participate in the identification and planning of a diabetes prevention project.     

Influences on infant–feeding beliefs and practices in an urban Aboriginal community

Abstract: The Victorian Aboriginal Health Service initiated a project to increase breastfeeding rates in the Melbourne Aboriginal community. The results of focus–group discussions on infant–feeding experiences and beliefs provided a wealth of information for the design of appropriate interventions. Most women wanted and expected to breast–feed. Some chose artificial feeding because of embarrassment, a belief that it is as good as breast–feeding, or perceptions that breast–feeding is painful and inconvenient. The most common reasons that women stopped breast–feeding were sore nipples, worries about their supply of milk and tiredness. Lack of knowledge, hospital practices, lack of support and appropriate advice, and lack of confidence and self–esteem contributed to these problems. Disruption of the passing on of knowledge of healthy infant–feeding practices between generations is another cultural loss suffered by Aboriginal communities. Efforts to restore traditional rates of breast–feeding need to be under Aboriginal control and to take account of these influences. ( Aust N Z J Public Health 1997; 21: 504–10)     

Food-purchasing behaviour in an Aboriginal community. 1. Results of a survey

Abstract: Attempts to improve the nutritional status of Aboriginal people through nutritional education programs should be informed by an understanding of contemporary patterns of food procurement, preparation and distribution. This paper describes the results of a survey of food-purchasing behaviour in a central-Australian Aboriginal community. Every transaction occurring in each food outlet in the community over a two-week period was recorded and the data analysed. The results show that women play a much greater role than men in food purchasing, that there is a significant recourse to takeaway foods, that there is a cycle of expenditure determined by distribution of pension and Community Development Employment Project cheques, and that children have sufficient disposable income to be able to provision themselves from the food outlets, so that much of their food consumption is not determined by adult members of their family.     

Working with community organizations for nutrition intervention

Effective community nutrition interventions require nutritionand health professionals to collaborate with organizations thatserve as hosts or loci for programs. These organizations includeworkplaces, schools, cafeterias, restaurants and supermarkets.Although nutritionists need to develop collaborative workingrelationships with community organizations, they often lackknowledge about organizational change and experience difficultyinitiating and maintaining relationships. This paper describesconcepts from theories of organizational change and an exampleof how they were used to help formulate guidelines for developingand analyzing successful collaborative relationships. In a consensusdevelopment workshop guidelines were developed in five areas:(1) goals for mutual relationships; (2) initiation: decidingwhether to work with an organization; (3) strategies for workingwith host organizations; (4) identifying sources of resistanceto change; and (5) warning signs and strategic retreat. Applyingthese guidelines should result in more effective collaborativerelationships for community nutrition education.     

Food-purchasing behaviour in an Aboriginal community. 2. Evaluation of an intervention aimed at children

Abstract: The previously described survey of food-purchasing behaviour in a central-Australian Aboriginal community demonstrated that children have sufficient disposable income to provision themselves directly from food outlets. Subsequently, a community-based intervention project developed strategies to provide healthier choices for these children. Two years after the initial survey, a follow-up survey was conducted in which all food purchases by children under the age of 15 in the community were recorded over a two-week period. The results demonstrate an improvement in the quality of foods and beverages purchased by children at the time of the second survey.     

The effectiveness of community based physical activity interventions with Aboriginal peoples

Though historically rare, Aboriginal individuals continue to experience greater levels of cardiovascular disease than the general Canadian population. Increasing evidence indicates rising sedentary behaviors from the traditional healthy and active lifestyles of this population.

Objective

This investigation aimed to examine the health benefits of a community-based physical activity intervention for Aboriginal Canadians.

Methods

From 2007–2010, 273 participants from the province of British Columbia, Canada were recruited through 21 Aboriginal communities representing male and females of wide ranging ages and health statuses. Participants attended identical testing of body composition, blood pressure, total and high density lipoprotein cholesterols, and physical activity behavior pre-and post-training. Participants completed one of three self-selected 13 week interventions: walking (n = 149), walk/running (n = 86), or running (n = 27).

Results

Improvements in health measures were observed for both male and female participants of all age groups and all three training programs. Male and female participants' improvements included waist circumference: 2.7 cm and 2.2 cm, total cholesterol: 0.18 mmol/L and 0.12 mmol/L, and systolic blood pressure: 2.6 mm Hg and 1.5 mm Hg, respectively.

Conclusions

The self-selected intensities program was successful in improving health status and physical activity for Aboriginal adults of all ages, genders and activity programs.