Smylie Janet, Kirst Maritt, McShane Kelly, Firestone Michelle, Wolfe Sara, O'Campo Patricia
Well Living House Action Research Centre for Indigenous Infant, Child and Family Health and Wellbeing, Centre for Research on Inner City Health, Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Canada; CIHR Applied Public Health Research Chair in Indigenous Health Knowledge and Information, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Canada.
Soc Sci Med. 2016 Feb;150:128-43. doi: 10.1016/j.socscimed.2015.12.019. Epub 2015 Dec 18.
Striking disparities in Indigenous maternal-child health outcomes persist in relatively affluent nations such as Canada, despite significant health promotion investments. The aims of this review were two-fold: 1. To identify Indigenous prenatal and infant-toddler health promotion programs in Canada that demonstrate positive impacts on prenatal or child health outcomes. 2. To understand how, why, for which outcomes, and in what contexts Indigenous prenatal and infant-toddler health promotion programs in Canada positively impact Indigenous health and wellbeing.
We systematically searched computerized databases and identified non-indexed reports using key informants. Included literature evaluated a prenatal or child health promoting program intervention in an Indigenous population in Canada. We used realist methods to investigate how, for whom, and in what circumstances programs worked. We developed and appraised the evidence for a middle range theory of Indigenous community investment-ownership-activation as an explanation for program success.
Seventeen articles and six reports describing twenty programs met final inclusion criteria. Program evidence of local Indigenous community investment, community perception of the program as intrinsic (mechanism of community ownership) and high levels of sustained community participation and leadership (community activation) was linked to positive program change across a diverse range of outcomes including: birth outcomes; access to pre- and postnatal care; prenatal street drug use; breast-feeding; dental health; infant nutrition; child development; and child exposure to Indigenous languages and culture.
These findings demonstrate Indigenous community investment-ownership-activation as an important pathway for success in Indigenous prenatal and infant-toddler health programs.
尽管在促进健康方面投入巨大，但在加拿大等相对富裕的国家，原住民母婴健康结果仍存在显著差异。本综述的目的有两个：1. 确定加拿大对产前或儿童健康结果有积极影响的原住民产前和婴幼儿健康促进项目。2. 了解加拿大的原住民产前和婴幼儿健康促进项目如何、为何、针对哪些结果以及在何种背景下对原住民健康和福祉产生积极影响。
我们系统地检索了计算机化数据库，并通过关键信息提供者确定了未编入索引的报告。纳入的文献评估了加拿大原住民人口中的产前或儿童健康促进项目干预措施。我们使用现实主义方法来研究项目如何、对谁以及在何种情况下发挥作用。我们开发并评估了一种中层理论的证据，即原住民社区投资 - 所有权 - 激活理论，以此来解释项目的成功。
17篇文章和6份报告描述了20个项目，这些项目符合最终纳入标准。当地原住民社区投资、社区将项目视为内在项目（社区所有权机制）以及高水平的持续社区参与和领导力（社区激活）的项目证据，与一系列不同结果的积极项目变化相关，这些结果包括：出生结果；获得产前和产后护理；产前街头毒品使用；母乳喂养；牙齿健康；婴儿营养；儿童发育；以及儿童接触原住民语言和文化。
这些发现表明，原住民社区投资 - 所有权 - 激活是原住民产前和婴幼儿健康项目取得成功的重要途径。
