Feasibility of a novel participatory multi-sector continuous improvement approach to enhance food security in remote Indigenous Australian communities

Abstract

BackgroundFood insecurity underlies and compounds many of the development issues faced by remote Indigenous communities in Australia. Multi-sector approaches offer promise to improve food security. We assessed the feasibility of a novel multi-sector approach to enhance community food security in remote Indigenous Australia.MethodA longitudinal comparative multi-site case study, the Good Food Systems Good Food for All Project, was conducted (2009–2013) with four Aboriginal communities. Continuous improvement meetings were held in each community. Data from project documents and store sales were used to assess feasibility according to engagement, uptake and sustainability of action, and impact on community diet, as well as identifying conditions facilitating or hindering these.ResultsEngagement was established where: the community perceived a need for the approach; where trust was developed between the community and facilitators; where there was community stability; and where flexibility was applied in the timing of meetings. The approach enabled stakeholders in each community to collectively appraise the community food system and plan action. Actions that could be directly implemented within available resources resulted from developing collaborative capacity. Actions requiring advocacy, multi-sectoral involvement, commitment or further resources were less frequently used. Positive shifts in community diet were associated with key areas where actions were implemented.ConclusionA multi-sector participatory approach seeking continuous improvement engaged committed Aboriginal and non-Aboriginal stakeholders and was shown to have potential to shift community diet. Provision of clear mechanisms to link this approach with higher level policy and decision-making structures, clarity of roles and responsibilities, and processes to prioritise and communicate actions across sectors should further strengthen capacity for food security improvement. Integrating this approach enabling local decision-making into community governance structures with adequate resourcing is an imperative.

Effect of nutrition interventions on diet-related and health outcomes of Aboriginal and Torres Strait Islander Australians: a systematic review

“…This review includes 12 cohort studies, 1 cohort39 with a ‘nested’ repeat cross-sectional study,44 2 repeat cross-sectional,40 54 2 interrupted time series,55 56 four case series53 57–59 and one each of retrospective pre–post study,60 multisite case study,61 non-randomised controlled study,37 stepped-wedge randomised controlled trial36 and an interrupted time series with a control group38 and a ‘nested’ cohort 45…”

“…Five studies (nine articles) described this intervention type 38–40 44 45 45 50 54 61. Two studies were assessed as cross-sectional40 50 54; one an interrupted time series with a control group38 (included a ‘nested’ cohort design)45; one a multisite case study61; and one a cohort39 (included a ‘nested’ cross-sectional design) 44. All were assessed as weak quality with two38 40 including additional impact evaluations both assessed as moderate 45 50.…”

Socioeconomic status, remoteness and tracking of nutritional status from childhood to adulthood in an Australian Aboriginal Birth Cohort: the ABC study

“…Nutrition education including cooking skills workshops, group education sessions and store interventions have been reported to have some positive effect on obesity in Indigenous communities according to a review study that included both remote and urban communities in Australia 41. Multisector participatory approaches to strengthen food systems in remote Indigenous communities are needed42 with a special focus on nutrition in the early life.…”

Effects of food policy actions on Indigenous Peoples’ nutrition-related outcomes: a systematic review

“…72 73 Harness the food supply chain and action across sectors to ensure coherence with health Six studies evaluated multisectoral interventions aimed at improving food and/or beverage supply chains. [90][91][92][93][94][95] Evidence from Australian remote Indigenous communities suggests community-driven and multisectoral collaboration to improve local food systems, supply chains and environments, can increase sales of fruit, vegetables and water and reduce sales of confectionary and sugarsweetened beverages. 91 92 94 95 Furthermore, the two North American studies demonstrated harnessing Indigenous and non-Indigenous food systems to deliver healthy food directly to community settings, such as schools or community centres, can increase intake of healthy foods (including traditional foods) and reduce food insecurity among Indigenous Peoples.…”