Abstract
BackgroundEvaluating program outcomes without considering how the program was implemented can cause misunderstandings and inefficiencies when initiating program improvements. In conjunction with a program evaluation, reported elsewhere, this paper theorises the process of implementing an Indigenous Australian maternal and child health program. The Baby Basket program was developed in 2009 for the remote Cape York region and aimed to improve the attendance and engagement of Indigenous women at antenatal and postnatal clinics through providing three baskets of maternal and baby goods and associated health education.MethodsConstructivist grounded theory methods were used to generate and analyse data from qualitative interviews and focus groups with Indigenous women who received the baskets, their extended family members, and healthcare workers who delivered them. Data was coded in NVivo with concepts iteratively compared until higher order constructs and their relationships could be modelled to explain the common purpose for participants, the process involved in achieving that purpose, key strategies, conditions and outcomes. Theoretical terms are italicised.ResultsProgram implementation entailed empowering families through a process of engaging and relating Murri (Queensland Indigenous) way. Key influencing conditions of the social environment were the remoteness of communities, keeping up with demand, families’ knowledge, skills and roles and organisational service approaches and capacities. Engaging and relating Murri way occurred through four strategies: connecting through practical support, creating a culturally safe practice, becoming informed and informing others, and linking at the clinic. These strategies resulted in women and families taking responsibility for health through making healthy choices, becoming empowered health consumers and advocating for community changes.ConclusionsThe theoretical model was applied to improve and revise Baby Basket program implementation, including increased recognition of the importance of empowering families by extending the home visiting approach up to the child’s third birthday. Engaging and relating Murri way was strengthened by formal recognition and training of Indigenous health workers as program leaders. This theoretical model of program implementation was therefore useful for guiding program improvements, and could be applicable to other Indigenous maternal and child health programs.
Highlights
Evaluating program outcomes without considering how the program was implemented can cause misunderstandings and inefficiencies when initiating program improvements
Key influencing conditions of the social environment were the remoteness of communities, keeping up with demand, families’ knowledge, skills and roles and organisational service approaches and capacities
In summary, within the remote Cape York communities, the Baby Basket program was implemented for the purpose of empowering families through the process of engaging and relating Murri way between women, their families and health service providers
Summary
Evaluating program outcomes without considering how the program was implemented can cause misunderstandings and inefficiencies when initiating program improvements. In conjunction with a program evaluation, reported elsewhere, this paper theorises the process of implementing an Indigenous Australian maternal and child health program. For the Australian states and territories for which data is availablea, in 2010, Indigenous child mortality remained more than double that of the non-Indigenous population (with 45 compared with 20 deaths per 100,000 children aged 1–4 years) [3]. Further reducing maternal and child health mortality requires government investment in innovative models to improve access to and the quality of Indigenous maternal and child health services and programs. Reviews of Indigenous Australian maternal and child health programs have documented evaluations of intervention models and a diversity of antenatal and postnatal program and service components [6,7,8]. Consistent with a review of Indigenous health promotion tools which found that only 30% publications reported intended or actual implementation processes [9], few of the Indigenous Australian maternal and child health studies reviewed had reported how programs were implemented [8,10]
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