Strengths and limitations of a tool for monitoring and evaluating First Peoples’ health promotion from an ecological perspective

Abstract

BackgroundAn ecological approach to health and health promotion targets individuals and the environmental determinants of their health as a means of more effectively influencing health outcomes. The approach has potential value as a means to more accurately capture the holistic nature of Australian First Peoples’ health programs and the way in which they seek to influence environmental, including social, determinants of health.MethodsWe report several case studies of applying an ecological approach to health program evaluation using a tool developed for application to mainstream public health programs in North America – Richard’s ecological coding procedure.ResultsWe find the ecological approach in general, and the Richard procedure specifically, to have potential for broader use as an approach to reporting and evaluation of health promotion programs. However, our experience applying this tool in academic and community-based program evaluation contexts, conducted in collaboration with First Peoples of Australia, suggests that it would benefit from cultural adaptations that would bring the ecological coding procedure in greater alignment with the worldviews of First Peoples and better identify the aims and strategies of local health promotion programs.ConclusionsEstablishing the cultural validity of the ecological coding procedure is necessary to adequately capture the underlying program activities of community-based health promotion programs designed to benefit First Peoples, and its collaborative implementation with First Peoples supports a human rights approach to health program evaluation.

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

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An Australian model of the First 1000 Days: an Indigenous-led process to turn an international initiative into an early-life strategy benefiting indigenous families

“…The year-long process of this Indigenous-led campaign of engagement [ 45 – 48 ] resulted in a broadening of the international 1000 days movement to create an Australian model with a holistic framework that supports resilience within, and is appropriate for, Indigenous communities. The First 1000 Days Australia model was built by adhering to Indigenous methodologies [ 43 , 66 , 67 ] a recognition of the centrality of culture that reinforces and strengthens families [ 38 ], and a holistic view of health and wellbeing [ 57 , 58 ]; This dynamic process has ensured that the First 1000 Days Australia is based on strengths-based empowerment and not deficit [ 68 ]. Specifically, the First 1000 Days Australia model includes strong community governance at regional and national levels, thereby obligating researcher accountability and binding participating organisations to a shared vision and set of strategies focusing on the family environment; increased antenatal and early years’ engagement; and service use and provision.…”

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

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“…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.…”