A pilot study of Aboriginal health promotion from an ecological perspective

Abstract

BackgroundFor health promotion to be effective in Aboriginal and Torres Strait Islander Communities, interventions (and their evaluation) need to work within a complex social environment and respect Indigenous knowledge, culture and social systems. At present, there is a lack of culturally appropriate evaluation methods available to practitioners that are capable of capturing this complexity. As an initial response to this problem, we used two non-invasive methods to evaluate a community-directed health promotion program, which aimed to improve nutrition and physical activity for members of the Aboriginal community of the Goulburn-Murray region of northern Victoria, Australia. The study addressed two main questions. First, for members of an Aboriginal sporting club, what changes were made to the nutrition environment in which they meet and how is this related to national guidelines for minimising the risk of chronic disease? Second, to what degree was the overall health promotion program aligned with an ecological model of health promotion that addresses physical, social and policy environments as well as individual knowledge and behaviour?MethodsRather than monitoring individual outcomes, evaluation methods reported on here assessed change in the nutrition environment (sports club food supply) as a facilitator of dietary change and the 'ecological' nature of the overall program (that is, its complexity with respect to numbers of targets, settings and strategies).ResultsThere were favourable changes towards the provision of a food supply consistent with Australian guidelines at the sports club. The ecological analysis indicated that the design and implementation of the program were consistent with an ecological model of health promotion.ConclusionsThe evaluation was useful for assessing the impact of the program on the nutrition environment and for understanding the ecological nature of program activities.

A Review of Programs That Targeted Environmental Determinants of Aboriginal and Torres Strait Islander Health

“…Changes in food supply were achieved through targeting remote stores [16,22,23,26,27,28,50], canteens at schools [16,26] and a sporting club [44], the last incorporating the “Fruit Share” program that provided fruit for club members on training nights. These activities were supported by staff development through health promotion training [44], and support from local councils in the form of air charters [23] and provision of office space for project workers [26].…”

“…Changes in food supply were achieved through targeting remote stores [16,22,23,26,27,28,50], canteens at schools [16,26] and a sporting club [44], the last incorporating the “Fruit Share” program that provided fruit for club members on training nights. These activities were supported by staff development through health promotion training [44], and support from local councils in the form of air charters [23] and provision of office space for project workers [26]. Breakfast programs for children were reported [26,44], as was education through school curriculum change [26], the engagement of Elders [23], and other education strategies such as “shelf talkers” and store tours to aid community members’ recognition of target foods [23,26,28].…”

“…These activities were supported by staff development through health promotion training [44], and support from local councils in the form of air charters [23] and provision of office space for project workers [26]. Breakfast programs for children were reported [26,44], as was education through school curriculum change [26], the engagement of Elders [23], and other education strategies such as “shelf talkers” and store tours to aid community members’ recognition of target foods [23,26,28]. A Healthy Lifestyles project in north-east Arnhemland also included a family food garden program that involved staff working with families to establish backyard gardens, a community market which allowed access to fresh fruits, bush foods, fish and shell-fish, and a policy of not selling deep-fried takeaway foods until at least 11 am [16].…”

A prospective evaluation of first people’s health promotion program design in the goulburn-murray rivers region

“…Rumbalara Football Netball Club stands out by focussing on promoting healthy lifestyles and preventative health programs rather than crisis intervention services [4]. All three ACCOs identified that their programs were not being evaluated and reported in ways that reflect how they address social determinants of First Peoples’ health and the holistic nature of their design [5]. This is not unique to this region or country [6–8].…”

“…We have previously used an ecological model as an indicator of health program complexity and design [5, 9] and found it to have value for this purpose, despite certain limitations [10]. In theory, health programs are more likely to be effective if they act to change the environment in which people live as well as working with individuals.…”