The impact of social determinants of health of Australian Indigenous women on access and engagement in maternal child health services.

Abstract

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. A qualitative study, guided by the methodological principles of narrative inquiry integrated with the Indigenous philosophy 'Dadirri', and thematic analysis of the data. 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. 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. 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. 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. 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 engagement 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.