Abstract
BackgroundThe Australian Nurse Family Partnership Program (ANFPP) is an evidence-based, home visiting program that offers health education, guidance, social and emotional support to first-time mothers having Aboriginal and/or Torres Strait Islander (First Nations) babies. The community-controlled sector identified the need for specialised support for first time mothers due to the inequalities in birthing and early childhood outcomes between First Nations’ and other babies in Australia. The program is based on the United States’ Nurse Family Partnership program which has improved long-term health outcomes and life trajectories for mothers and children. International implementation of the Nurse Family Partnership program has identified interagency service integration as key to program recruitment, retention, and efficacy. How the ANFPP integrates with other services in an Australian urban setting and how to improve this is not yet known. Our research explores the barriers and enablers to interagency service integration for the Australian Nurse Family Partnership Program ANFPP in an urban setting.MethodsA qualitative study using individual and group interviews. Purposive and snowball sampling was used to recruit clients, staff (internal and external to the program), Elders and family members. Interviews were conducted using a culturally appropriate ‘yarning’ method with clients, families and Elders and semi-structured interview guide for staff. Interviews were audio-recorded and transcribed prior to reflexive thematic analysis.ResultsSeventy-six participants were interviewed: 26 clients, 47 staff and 3 Elders/family members. Three themes were identified as barriers and three as enablers. Barriers: 1) confusion around program scope, 2) duplication of care, and 3) tensions over ‘ownership’ of clients. Enablers (existing and potential): 1) knowledge and promotion of the program; 2) cultural safety; and 3) case coordination, co-location and partnership forums.ConclusionEffective service integration is essential to maximise access and acceptability of the ANFPP; we provide practical recommendations to improve service integration in this context.
Highlights
Aboriginal and Torres Strait Islander families have strong, cohesive and nurturing cultural practices that contribute to healthy family functioning and child rearing [1]
Acronyms used include: NHV for Nurse Home Visitor, FPW for Family Partnership Worker, and MGP for Midwifery Group Practice
We found that referrals to the Australian Nurse Family Partnership Program (ANFPP) predominantly came from services within the same Aboriginal communitycontrolled health service (ACCHS), and rarely from hospitals or clinics, which is consistent with other studies [29, 36, 37]
Summary
Aboriginal and Torres Strait Islander ( referred to as First Nations) families have strong, cohesive and nurturing cultural practices that contribute to healthy family functioning and child rearing [1]. The ongoing impact of colonisation and systemic racism perpetuates structural, social and economic barriers to efforts by First Nations individuals, families and communities to improve and maintain their health and well-being [2, 3] This has resulted in significant health disparities, including three times greater maternal mortality and almost double the rates of infant mortality, higher rates of low birth weight and child hospitalisation when compared to other Australians [4, 5]; despite receiving significant policy attention, there has been little improvement in over a decade [4,5,6,7,8]. The Australian Nurse Family Partnership Program (ANFPP) is an evidence-based, home visiting program that offers health education, guidance, social and emotional support to first-time mothers having Aboriginal and/or Torres Strait Islander (First Nations) babies. Our research explores the barriers and enablers to interagency service integration for the Australian Nurse Family Partnership Program ANFPP in an urban setting
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