Co-Designing Health Service Evaluation Tools That Foreground First Nation Worldviews for Better Mental Health and Wellbeing Outcomes

Abstract

It is critical that health service evaluation frameworks include Aboriginal people and their cultural worldviews from design to implementation. During a large participatory action research study, Elders, service leaders and Aboriginal and non-Aboriginal researchers co-designed evaluation tools to test the efficacy of a previously co-designed engagement framework. Through a series of co-design workshops, tools were built using innovative collaborative processes that foregrounded Aboriginal worldviews. The workshops resulted in the development of a three-way survey that records the service experiences related to cultural safety from the perspective of Aboriginal clients, their carer/s, and the service staff with whom they work. The surveys centralise the role of relationships in client-service interactions, which strongly reflect their design from an Aboriginal worldview. This paper provides new insights into the reciprocal benefits of engaging community Elders and service leaders to work together to develop new and more meaningful ways of servicing Aboriginal families. Foregrounding relationships in service evaluations reinstates the value of human connection and people-centred engagement in service delivery which are central to rebuilding historically fractured relationships between mainstream services and Aboriginal communities. This benefits not only Aboriginal communities, but also other marginalised populations expanding the remit of mainstream services to be accessed by many.

The Health and Wellbeing of Indigenous and Tribal Peoples around the Globe: Ensuring and Promoting Best Practice in Research

“…A range of mechanisms across the life of the research project or program, from setting research priorities to ongoing communication to dissemination of results, were described. These included: membership of Indigenous and Tribal people on advisory groups, working groups, steering committees, and governance committees [ 7 , 9 , 10 , 11 , 13 , 14 , 15 , 16 , 23 , 25 , 27 , 30 , 32 , 33 , 34 , 37 ]; involvement of community Elders, other community leaders, and Tribal health centres [ 19 , 25 , 28 , 35 ]; formal and informal partnerships with Aboriginal Community-Controlled Health Organisations, Tribal health services and other community organisations [ 8 , 10 , 14 , 19 , 20 , 22 , 25 , 29 , 30 , 31 ]; hiring and training Indigenous research staff, especially from the relevant community/ies [ 7 , 9 , 10 , 13 , 16 , 18 , 23 , 35 ]; the use of community-based participatory research approaches, co-design, and consumer engagement and involvement [ 12 , 19 , 20 , 23 , 25 , 32 , 33 , 35 ]; and the involvement ...…”

“…In addition to approval by Human Research Ethics Committees and Institutional Review Boards, which are embedded within Western academic institutions, a range of other mechanisms for ensuring appropriate Indigenous and Tribal governance in research were described in the papers included in the Special Issue, such as: approval by a Tribal government, an Indigenous Ethics Committee (e.g., the Aboriginal Health and Medical Research Council’s ethics committee in New South Wales, Australia), or an Aboriginal Community Controlled Health Organisation [ 7 , 8 , 9 , 10 , 12 , 13 , 14 , 16 , 18 , 19 , 22 , 23 , 25 , 28 , 29 , 31 , 35 ]; the use of cultural reference groups and governance committees [ 11 , 13 , 16 , 19 , 23 , 25 , 27 , 33 , 34 ]; and having formal agreed Terms of Reference and/or Resolutions of Support [ 10 , 20 , 29 ].…”

“…Other studies reflected the priorities of government agencies, either through alignment with articulated strategies or through commissioned work [ 24 , 25 , 33 ]. Many studies reflected the expressed needs and priorities of Indigenous and Tribal communities, either directly or through community organisations, Tribal governments, and/or Indigenous/Tribal advisory committee members [ 7 , 8 , 10 , 12 , 14 , 19 , 20 , 22 , 23 , 28 , 30 , 31 , 33 , 34 , 35 ].…”

“…The resulting Special Issue includes 31 papers in total, with 21 from Australia [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ], 4 from the United States [ 28 , 29 , 30 , 31 ], 3 from Aotearoa/New Zealand [ 32 , 33 , 34 ], 1 from Canada [ 35 ], and 2 from authors in multiple countries [ 36 , 37 ]. This represents a substantial body of research on the health and wellbeing of Indigenous and Tribal peoples, possibly the largest collection ever published.…”

Defining collective capability in Australian evaluations that are conducted by, for and with Indigenous peoples for health programmes, policies and services: a concept analysis protocol

“…Existing frameworks and cultural protocols guiding evaluations of Aboriginal and Torres Strait Islander programmes and policies capture some elements of Indigenist approaches, and are intended to inform cross-cultural practices and commissioning processes. The work of Williams 7 , Wright et al 25 and Rogers et al 19 draw on codesign processes in evaluations that centres Aboriginal and Torres Strait Islander perspectives, experiences and leadership. These frameworks provide clear guidance of processes to ensure local knowledge and cultural protocols are embedded in the design and processes of evaluations.…”