- Title
- Access and engagement of First Nations women in maternal and child health services
- Creator
- Austin, Catherine
- Date
- 2023
- Type
- Text; Thesis; PhD
- Identifier
- http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/196587
- Identifier
- vital:18711
- Abstract
- This thesis explores and describes the engagement of First Nations women, with children from birth to five years of age, with Maternal and Child Health (MCH) services in Victoria, Australia. Identification of the factors that facilitate, support or hinder these women’s engagement with MCH services could strengthen the model of care to effectively engage First Nations women with these services. Access in the early years of a child’s life to integrated, effective, community-based services is a well-established predictor of a child’s successful transition to school and their lifelong education and employment outcomes. Such access is crucial in a child’s first 2,000 days (the period from conception to the child’s fifth year), which forms the foundation for a child’s lifetime development and health. Prior evaluative studies have shown that participation in MCH services in Victoria improves the health outcomes for children and families, particularly First Nations families. However, First Nations women and their children in Victoria show poorer health outcomes and lower participation in MCH services compared to non-Indigenous persons; this suggests a need to improve the current Victorian MCH service model. This thesis contributes recommendations for such improvements. The literature review (Chapter 2) identified the absence of a synthesis of qualitative studies of models of care to help guide MCH practice and innovation for all families, especially those at risk of child abuse and neglect. To address this gap, a three-phase qualitative study was conducted in the Glenelg Shire, Victoria, Australia, using narrative inquiry integrated with the Indigenous philosophy ‘Dadirri’. ‘Dadirri’, which emphasises deep and respectful listening, guided the development of the research design; this methodology assisted in understanding Indigenous culture and its sensitivities, building trust with the First Nations peoples involved in the studies, developing open-ended and conversational dialogue, and building respectful relationships. This method enabled First Nations women’s voices to be heard and the collection of rich data based on participants’ perspectives of and experiences with MCH services in Victoria. Study One (Chapter 4) recruited First Nations women residing in the Glenelg Shire, with at least one child aged birth to five years, to explore their perceptions and experiences of MCH services and barriers to accessing and engaging with MCH services. Study Two (Chapter 5) compared Study One data with accounts from MCH nurses working in Glenelg Shire. Study Three (Chapter 6) reviewed a piloting of the Early Assessment Referral Links (EARL) concept (developed by the researcher) that aims to improve First Nations women and their children’s access to and engagement with MCH services. EARL involved the core principles of narrative inquiry integrated with ‘Dadirri’. Study One and Two found that enabling factors for access and engagement include interventions that are culturally sensitive and effective; recognise the social determinates of health (SDOH) and social and emotional wellbeing; are timely, appropriate, culturally strong, flexible, holistic and community-based; support continuity of care and communication; and encourage early identification of risk, particularly of family violence (FV), and further assessment, intervention, referral and support in the child’s first 2,000 days. Barriers to access and engagement include an ineffective service model built on mistrust, poor communication due to cultural differences between client and provider (particularly around identification and disclosure of woman’s risk of FV), lack of continuity of care between services, limited flexibility of service delivery to suit individual needs, and a service model that does not recognise the importance of the SDOH and social and emotional wellbeing. Study Three results showed that participation of First Nations families in MCH services was consistently above the state average during the pilot period, and several First Nations families were referred to EARL stakeholders and other health professionals during the pilot. Further, there were increases in First Nations children being breastfed, fully immunised and attending Early Start Kindergarten, and identification of First Nations children at risk of abuse or neglect improved (with a significant increase in referrals for FV and child protection and significant decrease in episodes of out-of-home care). This thesis’s findings can support policy development. This research shows that timely, effective, holistic engagement with First Nations women in their child’s first 2,000 days, that respects their culture and facilitates genuine partnerships built on co-design and shared decision-making with the Indigenous community, needs to be an essential part of the MCH service model. Additionally, this thesis recommends adopting a strengths-based approach that respects First Nations peoples’ child-rearing practices and culture, and providing necessary training to MCH nurses who work with First Nations families. Keywords: child family health, continuity of care, First Nations women; Doctor of Philosophy
- Publisher
- Federation University Australia
- Rights
- Culturally sensitive
- Rights
- All metadata describing materials held in, or linked to, the repository is freely available under a CC0 licence
- Rights
- Copyright Catherine Austin
- Rights
- Restricted access by author indefinitely, page 174 Figure 8.5 The proposed "Child and Familyh Health Service model", due to pending copyright by author
- Subject
- Child family health; Continuity of care; First Nations women; Access; Engagement
- Full Text
- Thesis Supervisor
- Lewis, Andrew
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