Access and engagement of First Nations women in maternal and child health services
- Authors: Austin, Catherine
- Date: 2023
- Type: Text , Thesis , PhD
- Full Text:
- Description: 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
- Description: Doctor of Philosophy
- Authors: Austin, Catherine
- Date: 2023
- Type: Text , Thesis , PhD
- Full Text:
- Description: 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
- Description: Doctor of Philosophy
Improving the engagement of Aboriginal families with maternal and child health services : a new model of care
- Austin, Catherine, Arabena, Kerry
- Authors: Austin, Catherine , Arabena, Kerry
- Date: 2021
- Type: Text , Journal article
- Relation: Public Health Research and Practice Vol. 31, no. 2 (2021), p.
- Full Text:
- Reviewed:
- Description: Objectives: Access in the early years to integrated community-based services that are flexible in their approach, holistic and culturally strong is a proven critical predictor of a child's successful transition to school and lifelong education and employment outcomes, providing long-term wellbeing. Studies show that participation in maternal and child health (MCH) services in Victoria, Australia, improve health outcomes for children and families, particularly for Aboriginal families. Poorer health outcomes and lower participation rates for these families in MCH services suggest there is a need for an urgent review of the current service model. The purpose of this paper is to outline the Early Assessment Referral Links (EARL) concept that was trialled in the Glenelg Shire in Victoria, Australia (2009-2014) to improve the engagement of Aboriginal families in MCH services. Methods: Development of EARL involved the core principles of appreciative inquiry to change existing patterns of conversation and give voice to new and diverse perspectives. A broad cross-section of the Aboriginal community and their early years health service providers were consulted and stakeholders recruited. Regular meetings between these stakeholders, in consultation with the Aboriginal community, were held to identify families that weren't engaged in MCH services and also to identify families who required further assessment, intervention, referral and/or support, ideally from the preconception or antenatal periods. Outcome measures used to evaluate the EARL concept include stakeholder meetings data, numbers of referrals, and participation rates of women and children in MCH services. Results: Participation of Aboriginal women and children in MCH services was consistently above the state average during the pilot period, and significant numbers of Aboriginal women and children were referred to EARL stakeholders and other health professionals via EARL referrals. Additionally, there were increases in Aboriginal children being breastfed, fully immunised and attending Early Start Kindergarten. Identification of Aboriginal women and children at risk of vulnerability also improved with a dramatic increase in referrals for family violence and child protection, and decreased episodes of out-of-home care (OoHC) for children. Conclusions: Evaluation of pilot outcomes indicate that the EARL concept improved women and children's access to and engagement with MCH services, and identified more families at risk of vulnerability than the traditional MCH service model, particularly for Aboriginal women and children. © 2020 Austin and Arabena.
- Authors: Austin, Catherine , Arabena, Kerry
- Date: 2021
- Type: Text , Journal article
- Relation: Public Health Research and Practice Vol. 31, no. 2 (2021), p.
- Full Text:
- Reviewed:
- Description: Objectives: Access in the early years to integrated community-based services that are flexible in their approach, holistic and culturally strong is a proven critical predictor of a child's successful transition to school and lifelong education and employment outcomes, providing long-term wellbeing. Studies show that participation in maternal and child health (MCH) services in Victoria, Australia, improve health outcomes for children and families, particularly for Aboriginal families. Poorer health outcomes and lower participation rates for these families in MCH services suggest there is a need for an urgent review of the current service model. The purpose of this paper is to outline the Early Assessment Referral Links (EARL) concept that was trialled in the Glenelg Shire in Victoria, Australia (2009-2014) to improve the engagement of Aboriginal families in MCH services. Methods: Development of EARL involved the core principles of appreciative inquiry to change existing patterns of conversation and give voice to new and diverse perspectives. A broad cross-section of the Aboriginal community and their early years health service providers were consulted and stakeholders recruited. Regular meetings between these stakeholders, in consultation with the Aboriginal community, were held to identify families that weren't engaged in MCH services and also to identify families who required further assessment, intervention, referral and/or support, ideally from the preconception or antenatal periods. Outcome measures used to evaluate the EARL concept include stakeholder meetings data, numbers of referrals, and participation rates of women and children in MCH services. Results: Participation of Aboriginal women and children in MCH services was consistently above the state average during the pilot period, and significant numbers of Aboriginal women and children were referred to EARL stakeholders and other health professionals via EARL referrals. Additionally, there were increases in Aboriginal children being breastfed, fully immunised and attending Early Start Kindergarten. Identification of Aboriginal women and children at risk of vulnerability also improved with a dramatic increase in referrals for family violence and child protection, and decreased episodes of out-of-home care (OoHC) for children. Conclusions: Evaluation of pilot outcomes indicate that the EARL concept improved women and children's access to and engagement with MCH services, and identified more families at risk of vulnerability than the traditional MCH service model, particularly for Aboriginal women and children. © 2020 Austin and Arabena.
Models and interventions to promote and support engagement of first nations women with maternal and child health services : an integrative literature review
- Austin, Catherine, Hills, Danny, Cruickshank, Mary
- Authors: Austin, Catherine , Hills, Danny , Cruickshank, Mary
- Date: 2022
- Type: Text , Journal article
- Relation: Children Vol. 9, no. 5 (2022), p.
- Full Text:
- Reviewed:
- Description: Background: Studies show that participation in maternal and child health (MCH) services improves health outcomes for First Nations families. However, accessing MCH services can be associated with fear, anxiety, and low attendance at subsequent appointments. Objective: To identify the existing knowledge of models/interventions that support engagement of First Nations women with MCH services in the child’s first five years. Methods: An integrative review was undertaken of full-text, peer-reviewed journal articles and grey literature, which were analysed to identify barriers and enabling factors that influenced the engagement of First Nations families with MCH services. Results: Enabling factors that influenced the engagement with MCH services included service models/interventions that are timely and appropriate, and effective integrated community-based services that are flexible, holistic, culturally strong, and encourage earlier identification of risk and further assessment, intervention, referral, and support from the antenatal period to the child’s fifth birthday. Barriers to engagement included inefficient communication, lack of understanding, cultural differences between the client and the provider, poor continuity of care, limited flexibility of service delivery to meet individual needs, and a health care model that does not recognise the importance of the social determinants of health and wellbeing. Discussion: Timely, effective, holistic engagement with First Nations women during their child’s first 2000 days, which 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 if health care providers seek to practise within First Nations communities. Conclusion: Improving engagement with MCH services is important for First Nations families, the nursing practice, and public health. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.
- Authors: Austin, Catherine , Hills, Danny , Cruickshank, Mary
- Date: 2022
- Type: Text , Journal article
- Relation: Children Vol. 9, no. 5 (2022), p.
- Full Text:
- Reviewed:
- Description: Background: Studies show that participation in maternal and child health (MCH) services improves health outcomes for First Nations families. However, accessing MCH services can be associated with fear, anxiety, and low attendance at subsequent appointments. Objective: To identify the existing knowledge of models/interventions that support engagement of First Nations women with MCH services in the child’s first five years. Methods: An integrative review was undertaken of full-text, peer-reviewed journal articles and grey literature, which were analysed to identify barriers and enabling factors that influenced the engagement of First Nations families with MCH services. Results: Enabling factors that influenced the engagement with MCH services included service models/interventions that are timely and appropriate, and effective integrated community-based services that are flexible, holistic, culturally strong, and encourage earlier identification of risk and further assessment, intervention, referral, and support from the antenatal period to the child’s fifth birthday. Barriers to engagement included inefficient communication, lack of understanding, cultural differences between the client and the provider, poor continuity of care, limited flexibility of service delivery to meet individual needs, and a health care model that does not recognise the importance of the social determinants of health and wellbeing. Discussion: Timely, effective, holistic engagement with First Nations women during their child’s first 2000 days, which 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 if health care providers seek to practise within First Nations communities. Conclusion: Improving engagement with MCH services is important for First Nations families, the nursing practice, and public health. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.
The impact of social determinants of health of Australian Indigenous women on access and engagement in maternal child health services
- Authors: Austin, Catherine
- Date: 2023
- Type: Text , Journal article
- Relation: Journal of Advanced Nursing Vol. 79, no. 5 (2023), p. 1815-1829
- Full Text:
- Reviewed:
- Description: Aims: To explore the impact of social determinants of health and health outcomes of Australian Indigenous women on their access and engagement in maternal child health services. Design: A qualitative study, guided by the methodological principles of narrative inquiry integrated with the Indigenous philosophy ‘Dadirri’, and thematic analysis of the data. Methods: Interviews of 35 Aboriginal mothers with children aged birth to 5 years in December 2021, to explore factors that influence their access and engagement in maternal child health services. Results: Enabling factors that influence access and engagement of Indigenous women in maternal child health services include service models or interventions that are culturally sensitive and effective. Models that recognize the social determinants of health and well-being, are timely, appropriate, culturally strong, flexible, holistic and effective community-based services that support continuity of care and communication and encourage earlier identification of risk and further assessment, intervention, referral and support from the antenatal period to the child's fifth birthday (the first 2000 days), also support access and engagement. Barriers to access and engagement include an ineffective service model built on mistrust and poor communication from cultural differences between client and provider, a lack of continuity of care between services, limited flexibility of service delivery to suit individual needs and a healthcare model that does not recognize the importance of the social determinants of health and well-being. Conclusion: Nurses' understanding of Indigenous culture, and the impact of the social determinants of health and health outcomes on the well-being of Indigenous women, is critical to improve their access and engagement in maternal child health services. Impact: The findings of this research support the benefit of models or interventions that recognize the interactions and effects of the social determinants of health and health outcomes of Indigenous women and their healthcare access. Patient or Public Contribution: Data from Indigenous mothers residing in the Glenelg Shire with at least one child aged birth to 5 years were collected through face-to-face, in-depth semi-structured discussion (‘yarning’) at the Dhauwurd Wurrung Elderly and Community Health Service and the Winda-Mara Aboriginal Corporation Aboriginal and Community Controlled Health Organizations (ACCHO's) in December 2021, co-facilitated by key staff from the ACCHO's. To ensure cultural safety and an Indigenous lens to the research, consultation with traditional owners residing in the Glenelg Shire was sourced to assist with the development of the research guide and to develop interview questions. A panel of experts was then consulted to clarify the relevance and clarity of each question/discussion prompt on the indicative interview schedule and establish face validity. The panel of experts comprised of the research project team, an experienced Maternal and Child Health (MCH) nurse researcher and key representatives from the Victorian Aboriginal Community Controlled Health Organization (VACCHO) and the ACCHO sites. A small number of the target group, independent of the research, piloted the questions. Any valid suggestions from the expert panel and pilot testing were incorporated into the interview schedule design and clarifications were made to the questions/prompts where appropriate. Following full approval of the research, the Chief Executive Officers (CEO's) of the two ACCHO's were provided with an overview of the project and timeframes, and an Indigenous employee within each ACCHO was appointed by the CEO as a ‘site coordinator’ to act as the chief point of contact with the project team and assist with recruitment of discussion participants. Women who met the inclusion criteria were then invited to participate in the research. To ensure procedural and interpretative rigour, and to gain a deeper, comprehensive insight and understanding of First Nation women's access and engage ent in MCH Services, the ACCHO Site Coordinators, key staff from VACCHO and an Indigenous academic consultant with research experience interviewing Indigenous mothers in ‘the first 1000 days’ of their child's life, also participated in the analysis of the data. © 2022 The Author. Journal of Advanced Nursing published by John Wiley & Sons Ltd.
- Authors: Austin, Catherine
- Date: 2023
- Type: Text , Journal article
- Relation: Journal of Advanced Nursing Vol. 79, no. 5 (2023), p. 1815-1829
- Full Text:
- Reviewed:
- Description: Aims: To explore the impact of social determinants of health and health outcomes of Australian Indigenous women on their access and engagement in maternal child health services. Design: A qualitative study, guided by the methodological principles of narrative inquiry integrated with the Indigenous philosophy ‘Dadirri’, and thematic analysis of the data. Methods: Interviews of 35 Aboriginal mothers with children aged birth to 5 years in December 2021, to explore factors that influence their access and engagement in maternal child health services. Results: Enabling factors that influence access and engagement of Indigenous women in maternal child health services include service models or interventions that are culturally sensitive and effective. Models that recognize the social determinants of health and well-being, are timely, appropriate, culturally strong, flexible, holistic and effective community-based services that support continuity of care and communication and encourage earlier identification of risk and further assessment, intervention, referral and support from the antenatal period to the child's fifth birthday (the first 2000 days), also support access and engagement. Barriers to access and engagement include an ineffective service model built on mistrust and poor communication from cultural differences between client and provider, a lack of continuity of care between services, limited flexibility of service delivery to suit individual needs and a healthcare model that does not recognize the importance of the social determinants of health and well-being. Conclusion: Nurses' understanding of Indigenous culture, and the impact of the social determinants of health and health outcomes on the well-being of Indigenous women, is critical to improve their access and engagement in maternal child health services. Impact: The findings of this research support the benefit of models or interventions that recognize the interactions and effects of the social determinants of health and health outcomes of Indigenous women and their healthcare access. Patient or Public Contribution: Data from Indigenous mothers residing in the Glenelg Shire with at least one child aged birth to 5 years were collected through face-to-face, in-depth semi-structured discussion (‘yarning’) at the Dhauwurd Wurrung Elderly and Community Health Service and the Winda-Mara Aboriginal Corporation Aboriginal and Community Controlled Health Organizations (ACCHO's) in December 2021, co-facilitated by key staff from the ACCHO's. To ensure cultural safety and an Indigenous lens to the research, consultation with traditional owners residing in the Glenelg Shire was sourced to assist with the development of the research guide and to develop interview questions. A panel of experts was then consulted to clarify the relevance and clarity of each question/discussion prompt on the indicative interview schedule and establish face validity. The panel of experts comprised of the research project team, an experienced Maternal and Child Health (MCH) nurse researcher and key representatives from the Victorian Aboriginal Community Controlled Health Organization (VACCHO) and the ACCHO sites. A small number of the target group, independent of the research, piloted the questions. Any valid suggestions from the expert panel and pilot testing were incorporated into the interview schedule design and clarifications were made to the questions/prompts where appropriate. Following full approval of the research, the Chief Executive Officers (CEO's) of the two ACCHO's were provided with an overview of the project and timeframes, and an Indigenous employee within each ACCHO was appointed by the CEO as a ‘site coordinator’ to act as the chief point of contact with the project team and assist with recruitment of discussion participants. Women who met the inclusion criteria were then invited to participate in the research. To ensure procedural and interpretative rigour, and to gain a deeper, comprehensive insight and understanding of First Nation women's access and engage ent in MCH Services, the ACCHO Site Coordinators, key staff from VACCHO and an Indigenous academic consultant with research experience interviewing Indigenous mothers in ‘the first 1000 days’ of their child's life, also participated in the analysis of the data. © 2022 The Author. Journal of Advanced Nursing published by John Wiley & Sons Ltd.
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