Empowering families by engaging and relating Murri way: a grounded theory study of the implementation of the Cape York Baby Basket program

Abstract

BackgroundEvaluating program outcomes without considering how the program was implemented can cause misunderstandings and inefficiencies when initiating program improvements. In conjunction with a program evaluation, reported elsewhere, this paper theorises the process of implementing an Indigenous Australian maternal and child health program. The Baby Basket program was developed in 2009 for the remote Cape York region and aimed to improve the attendance and engagement of Indigenous women at antenatal and postnatal clinics through providing three baskets of maternal and baby goods and associated health education.MethodsConstructivist grounded theory methods were used to generate and analyse data from qualitative interviews and focus groups with Indigenous women who received the baskets, their extended family members, and healthcare workers who delivered them. Data was coded in NVivo with concepts iteratively compared until higher order constructs and their relationships could be modelled to explain the common purpose for participants, the process involved in achieving that purpose, key strategies, conditions and outcomes. Theoretical terms are italicised.ResultsProgram implementation entailed empowering families through a process of engaging and relating Murri (Queensland Indigenous) way. Key influencing conditions of the social environment were the remoteness of communities, keeping up with demand, families’ knowledge, skills and roles and organisational service approaches and capacities. Engaging and relating Murri way occurred through four strategies: connecting through practical support, creating a culturally safe practice, becoming informed and informing others, and linking at the clinic. These strategies resulted in women and families taking responsibility for health through making healthy choices, becoming empowered health consumers and advocating for community changes.ConclusionsThe theoretical model was applied to improve and revise Baby Basket program implementation, including increased recognition of the importance of empowering families by extending the home visiting approach up to the child’s third birthday. Engaging and relating Murri way was strengthened by formal recognition and training of Indigenous health workers as program leaders. This theoretical model of program implementation was therefore useful for guiding program improvements, and could be applicable to other Indigenous maternal and child health programs.

Conceptualizing the Association Between Community Participation and CQI in Aboriginal and Torres Strait Islander PHC Services

“…Our study uncovered working examples of two-way sharing in Indigenous PHC health activities. These examples build upon other excellent health examples of Indigenous community participation that have been recorded (Bond et al, 2016;McCalman et al, 2015;Sherwood et al, 2015;Singer, Bennett-Levy, & Rotumah, 2015). However, there are many examples that remain unrecorded, with the result that the empirical data needed to advance conceptual development and practical guidelines for effective community participation in Indigenous settings are incomplete.…”

Community Awareness Pregnant Women and Child Health in Four North Carolina County

“…For instance, the successful Centering Parenting model shifts the focus from clinician dominant to a supportive group that focuses on partnerships among families and communities empowered by skills and knowledge to focus on prevention based health for mothers and children [11]. In rural Australian communities a home visit with materials using the indigenous culture is well received by the natives and is successful at improving pregnancy and child health outcomes [12]. One method community engaged initiatives increase support for children and pregnant teenagers are via strength of interested community members and collaborations, such as health departments, businesses, and the public school system [2,14].…”

“…One method to build trust "outside the circle, " called Centering Parenting, focuses on group sessions with health assessment, education, and support for women during and after pregnancy [11]. Another method to build trust "outside the circle" and increase knowledge of pregnant women and new mothers uses a combination of maternal supplies, educational material (i.e., nutrition, exercise, smoking, alcohol use, care of a baby) and a home visit within rural communities [12]. These methods increase knowledge and responsibility of women for the health of themselves and their child while enabling communication between new mothers and health care workers.…”

From Consultation to Application: Practical Solutions for Improving Maternal and Neonatal Outcomes for Adolescent Aboriginal Mothers at a Local Level

“…However, despite these risk factors, there is also evidence that many adolescent mothers have healthy babies and adjust well to early parenting, particularly when they have strong family and community support and access to high quality maternity health and social services they are confident to attend [11,12,13]. Recent studies have shown that for some young women motherhood has the potential to be transformative [14,15], giving them a sense of purpose in their lives, and preventing them from heading down the “wrong track” (p. 713) [16] .…”