Improving Aboriginal Maternal Health by Strengthening Connection to Culture, Family and Community

Abstract

(1) Background: To explore the function of smoking in Aboriginal women’s lives from a trauma-informed, women-centred approach in order to inform the design of a culturally meaningful smoking cessation program for women living in the Pilbara, Western Australia; (2) Methods: Qualitative and Community Based Participatory Action Research (CBPAR) was used to discover what Aboriginal women know about smoking, the specific contextual issues that influence their smoking, and what community supports are available to help them quit smoking. Inductive analysis was used to determine key themes; (3) Results: 25 Aboriginal women (smokers, non-smokers, and ex-smokers) participated in focus groups or individual interviews. Women smoked to deal with stress, trauma and for maintaining social connections. Women who stopped smoking did so on their own when the reason was important enough or when they saw alternative ways of living. Creating safe places to bring women together to yarn about women’s business and link with health services was identified as critical to support women to stop smoking. Conclusions: Strategies to address smoking need to bring community, culture and health together in a meaningful way for women and their families; build on existing community strengths; and educate communities about the effects of smoking, and health professionals about how to support women to stop smoking.

Rates of breast feeding and associated factors for First Nations infants in a hospital with a culturally specific caseload midwifery model in Victoria, Australia: a cohort study

“…In this study, we found that women who did not smoke were more likely to breast feed at 3 months. Early and targeted culturally appropriate smoking cessation advice is required,37 38 with ongoing support during and after pregnancy to prevent relapse. In this study, although maternal age was associated with breast feeding at the univariate level (younger women being less likely to breast feed), this did not remain significant in the multivariate model.…”

Successes and challenges of primary health care in Australia: A scoping review and comparative analysis

“…While there might be several success factors for the provision of comprehensive PC, consecutive health system reforms [29,55,87], continued government commitment [29,55,69,87] and effective implementation of the current PHNs to provide culturally informed holistic PHC that address social and structural determinants of health [25]. Yet, being socially disadvantaged or racial discrimination [30,36,50,98,116,128], cost and financial barriers [61,95,96,101,131,133], regional / geographic variations [61,67,93,128], health disparity (equity / inequality) [17,25,34,127], communication barriers and lack of social connectedness with indigenous people's culture [50,98] are persistent challenges of accessibility, acceptability, and quality of PHC. Strengthening integrated, accessible, quality and culturally appropriate care for disadvantaged, culturally and linguistically diverse, Aboriginal and Torres Strait Islander people should be priority.…”

“…These achievements could be due to adaptive and need-driven health care reforms so far [29,55,87], the due emphasis on preventive care with good behavioural risk assessment [117,129,130], improved person-centredness of PC [1,4,17,24,76,138] and good evidence-based practice at the PC settings [56,106]. However, there is a wide range of variations in the quality of PHC care [52] which may be linked with a lack of effective interagency linkage [26], low socio-economic status [30,36,50,98,116,128], geographic barriers [61,67,93,128], cultural, and racial discrimination [30,36,123,128]. This implies that the implementation of continuous quali- ty improvement (CQI) [82,112,124] should be further aligned with the identified barriers.…”

“…Studies also reported that cultural respect at the PHC level shows a positive result in addressing social determinants of health [30,98]. However, communication barriers, racial discrimination [30], and low level of health professionals' social connectedness with indigenous people's culture [50,98] are some of the barriers to addressing social determinants of health and improving access to PHC services (Table S1 in the Online Supplementary Document). Physical resources and health human resource factors are also key factors explaining low access to PHC.…”

“…, in our scoping review, 36 studies[17,25,30,34,36,44,45,50,53,54,61,65,67,71,72,74,75,79,83,85,90,93,95,96,98- 102,116,122,127,128,131-133] assessed various indicators of access to PHC. Of these studies, 15 studies reported service access[36,45,53,54,71,72,74,83,85,90,99,100,102,122,132), three reported acceptability[44,65,75] and the rest of the studies assessed explanatory factors, barriers and challenges of access and coverage of PHC[17,25,30,34,50,61,67,79,93,95,96,98,101,116,127,128,131,133] (Table…”