Lowell Anne, Kildea Sue, Liddle Marlene, Cox Barbara, Paterson Barbara
Research Centre for Health and Wellbeing, Charles Darwin University, Ellengowan Drive, Darwin, Northern Territory, Australia.
Midwifery Research Unit, Mater Research Institute, School of Nursing and Midwifery, University of Queensland, Brisbane, Queensland, Australia.
BMC Pregnancy Childbirth. 2015 Feb 5;15:19. doi: 10.1186/s12884-015-0433-3.
The Strong Women, Strong Babies, Strong Culture Program (the Program) evolved from a recognition of the value of Aboriginal knowledge and practice in promoting maternal and child health (MCH) in remote communities of the Northern Territory (NT) of Australia. Commencing in 1993 it continues to operate today. In 2008, the NT Department of Health commissioned an evaluation to identify enabling factors and barriers to successful implementation of the Program, and to identify potential pathways for future development. In this paper we focus on the evaluation findings related specifically to the role of Aborignal cultural knowledge and practice within the Program.
A qualitative evaluation utilised purposive sampling to maximise diversity in program history and Aboriginal culture. Semi-structured, in-depth interviews with 76 participants were recorded in their preferred language with a registered Interpreter when required. Thematic analysis of data was verified or modified through further discussions with participants and members of the evaluation team.
Although the importance of Aboriginal knowledge and practice as a fundamental component of the Program is widely acknowledged, there has been considerable variation across time and location in the extent to which these cultural dimensions have been included in practice. Factors contributing to this variation are complex and relate to a number of broad themes including: location of control over Program activities; recognition and respect for Aboriginal knowledge and practice as a legitimate component of health care; working in partnership; communication within and beyond the Program; access to transport and working space; and governance and organisational support.
We suggest that inclusion of Aboriginal knowledge and practice as a fundamental component of the Program is key to its survival over more than twenty years despite serious challenges. Respect for the legitimacy of Aboriginal knowledge and practice within health care, a high level of community participation and control supported through effective governance and sufficient organisational commitment as well as competence in intercultural collaborative practice of health staff are critical requirements for realising the potential for cultural knowledge and practice to improve Aboriginal health outcomes.
“强壮女性、强壮婴儿、强壮文化计划”（该计划）源于认识到澳大利亚北领地（NT）偏远社区中土著知识与实践在促进母婴健康（MCH）方面的价值。该计划始于1993年，至今仍在运行。2008年，北领地卫生部委托进行一项评估，以确定该计划成功实施的促成因素和障碍，并确定未来发展的潜在途径。在本文中，我们重点关注与该计划中土著文化知识和实践的作用相关的评估结果。
采用定性评估，通过目的抽样以最大限度地增加计划历史和土著文化的多样性。对76名参与者进行半结构化的深入访谈，必要时由注册口译员以他们首选的语言进行记录。通过与参与者和评估团队成员进一步讨论，对数据进行主题分析并进行验证或修改。
尽管土著知识和实践作为该计划的基本组成部分的重要性得到广泛认可，但这些文化层面在实践中的纳入程度在不同时间和地点存在很大差异。导致这种差异的因素很复杂，涉及多个广泛主题，包括：对计划活动的控制地点；对土著知识和实践作为医疗保健合法组成部分的认可和尊重；合作伙伴关系；计划内外的沟通；交通和工作空间的获取；以及治理和组织支持。
我们认为，将土著知识和实践纳入该计划的基本组成部分是其在面临严峻挑战的情况下仍能存续二十多年的关键。尊重土著知识和实践在医疗保健中的合法性、通过有效治理和足够的组织承诺以及卫生工作人员跨文化协作实践能力支持的高水平社区参与和控制，是实现文化知识和实践改善土著健康结果潜力的关键要求。
