McCalman Janya, Heyeres Marion, Campbell Sandra, Bainbridge Roxanne, Chamberlain Catherine, Strobel Natalie, Ruben Alan
Central Queensland University, Cairns, Australia.
James Cook University, Cairns, Australia.
BMC Pregnancy Childbirth. 2017 Feb 21;17(1):71. doi: 10.1186/s12884-017-1247-2.
Primary healthcare services in Australia, Canada, New Zealand and the United States have embraced the concept of family-centred care as a promising approach to supporting and caring for the health of young Indigenous children and their families. This scoping review assesses the quality of the evidence base and identifies the published literature on family- centred interventions for Indigenous early childhood wellbeing.
Fourteen electronic databases, grey literature sources and the reference lists of Indigenous maternal and child health reviews were searched to identify relevant publications from 2000 to 2015. Studies were included if the intervention was: 1) focussed on Indigenous children aged from conception to 5 years from the abovementioned countries; 2) led by a primary healthcare service; 3) described or evaluated; and 4) scored greater than 50% against a validated scale for family-centredness. The study characteristics were extracted and quality rated. Reported aims, strategies, enablers and outcomes of family-centredcare were identified using grounded theory methods.
Eighteen studies (reported in 25 publications) were included. Three were randomised controlled studies; most were qualitative and exploratory in design. More than half of the publications were published from 2012 to 2015. The overarching aim of interventions was to promote healthy families. Six key strategies were to: support family behaviours and self- care, increase maternal knowledge, strengthen links with the clinic, build the Indigenous workforce, promote cultural/ community connectedness and advocate for social determinants of health. Four enablers were: competent and compassionate program deliverers, flexibility of access, continuity and integration of healthcare, and culturally supportive care. Health outcomes were reported for Indigenous children (nutritional status; emotional/behavioural; and prevention of injury and illness); parents/caregivers (depression and substance abuse; and parenting knowledge, confidence and skills); health services (satisfaction; access, utilization and cost) and community/cultural revitalisation.
The evidence for family-centred interventions is in the early stages of development, but suggests promise for generating diverse healthcare outcomes for Indigenous children and their parents/caregivers, as well as satisfaction with and utilisation of healthcare, and community/cultural revitalisation. Further research pertaining to the role of fathers in family-centred care, and the effects and costs of interventions is needed.
澳大利亚、加拿大、新西兰和美国的初级医疗服务已接受以家庭为中心的护理理念，将其视为支持和关爱原住民幼儿及其家庭健康的一种有前景的方法。本综述评估了证据基础的质量，并确定了关于以家庭为中心的原住民幼儿福祉干预措施的已发表文献。
检索了14个电子数据库、灰色文献来源以及原住民母婴健康综述的参考文献列表，以识别2000年至2015年的相关出版物。如果干预措施符合以下条件，则纳入研究：1）针对上述国家中从出生到5岁的原住民儿童；2）由初级医疗服务机构主导；3）进行了描述或评估；4）在经过验证的以家庭为中心的量表上得分超过50%。提取研究特征并进行质量评级。使用扎根理论方法确定以家庭为中心护理的报告目标、策略、促进因素和结果。
纳入了18项研究（发表在25篇出版物中）。3项为随机对照研究；大多数在设计上是定性和探索性的。超过一半的出版物发表于2012年至2015年。干预措施的总体目标是促进家庭健康。六个关键策略是：支持家庭行为和自我护理、增加母亲知识、加强与诊所的联系、培养原住民劳动力、促进文化/社区联系以及倡导健康的社会决定因素。四个促进因素是：有能力且富有同情心的项目实施者、获取服务的灵活性、医疗保健的连续性和整合性以及具有文化支持性的护理。报告了原住民儿童的健康结果（营养状况、情绪/行为以及预防伤害和疾病）；父母/照顾者（抑郁症和药物滥用；育儿知识、信心和技能）；医疗服务（满意度、获取、利用和成本）以及社区/文化复兴。
以家庭为中心的干预措施的证据尚处于发展初期，但表明有望为原住民儿童及其父母/照顾者带来多样化的医疗保健结果，以及提高对医疗保健的满意度和利用率，促进社区/文化复兴。需要进一步研究父亲在以家庭为中心的护理中的作用，以及干预措施的效果和成本。
