Implementing the Baby One Program: a qualitative evaluation of family-centred child health promotion in remote Australian Aboriginal communities

Abstract

BackgroundA healthy start predicts better health in later life. Many remote-living Aboriginal and Torres Strait Islander Australian families lack access to consistent, culturally-safe health services. This paper presents a study of implementation of the Baby One Program (BOP). The BOP was designed as a family-centred, Indigenous Healthworker-led, home-visiting model of care focused on promoting family health to give children the best start to life. It was developed by Aboriginal community-controlled Apunipima Cape York Health Council and delivered in Queensland Cape York remote communities. We aimed to determine how the BOP was implemented, enablers, strategies used and formative implementation outcomes.MethodsThe qualitative approach utilised theoretical and purposive sampling to explore people’s experiences of a program implementation process. Data were generated from semi-structured interviews with four family members enrolled in the BOP and 24 Apunipima staff members. In addition, twenty community members, including two program users, participated in a men’s community focus group. The findings are presented according to themes arising from the data.ResultsThe BOP was rolled out in nine remote Cape York communities between July 2014 and December 2015 and there was high uptake. Indigenous Healthworkers were supported by midwives and maternal and child health nurses to deliver health education to 161 eligible families. The key to effective implementation of family-centred care appeared to be the relationships formed between health practitioners, especially Indigenous Healthworkers, and families. The data revealed the following themes: challenging environments for new families and valuing cultural ways, resourcing program delivery, working towards a team approach, negotiating the cultural interface, engaging families, exchanging knowledge through ‘yarning’, strengthening the workforce, and seeing health changes in families. Healthworker education and training, and knowledge exchange between Healthworkers, midwives and nurses was critical to program effectiveness. The program continues to grow despite substantial logistic, financial and practical challenges.ConclusionsThis study describes an evolving process and explores how health providers connect with families and how the program responds to family and cultural issues. Program development is ongoing; strengthened by more community-level involvement, embedded strategies for ongoing self-evaluation and continuous quality improvements that are responsive to family needs.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1711-7) contains supplementary material, which is available to authorized users.

Working together in Aboriginal health: a framework to guide health professional practice

“…Authors highlight the need to work in partnership [16][17][18][19][20], be flexible [21], build relationships [17,21], get to know Aboriginal people [17,22] and reflect on their positions of privilege [23,24]. Programs often expand on the 'build relationships' principle to highlight that shared trust and respect are required in order to bring about sustained health change in Aboriginal communities [17,23,25,26]. However, this literature typically does not provide concrete examples of how to action these broad principles, particularly in relation to working together in cross-cultural teams in Aboriginal health.…”

“When I got the news”: Aboriginal fathers in the Kimberley region yarning about their experience of the antenatal period

“…These findings dovetail with contemporary discourse that positions fathers as involved, 8 attached 9 and nurturing 10 . Models of ANC that view the family as a system and engage fathers have been slow to emerge in Australia 11 …”

“…10 Models of ANC that view the family as a system and engage fathers have been slow to emerge in Australia. 11 …”

“…family as a system and engage fathers have been slow to emerge in Australia. 11 Involving fathers in ANC is viewed by health care providers as a means to paternal education about the pregnancy, birth, changes in the family with the arrival of the child, mental health during the perinatal period, and the positive impacts of paternal involvement in infant care. 12,13 Early paternal involvement is highly correlated with continued paternal involvement throughout childhood, 14 and positively affects children's outcomes in the long-term as measured through reduced behavioural and psychological problems, criminality and socioeconomic disadvantage.…”

The ongoing effect of diabetes during pregnancy and the impact on infants

“…Aboriginal Community Controlled Health Organisations and First Nation health services are well placed to deliver this program of care to their families. [6 , 7] …”