College of Nursing, University of Saskatchewan, Health Sciences Building - 1A10, 107 Wiggins Road, Box 6, Saskatoon, SK, S7N 5E5, Canada.
Department of Indigenous Studies, University of Lethbridge, A410 University Hall, Lethbridge, AB, T1K 3M4, Canada.
Int J Equity Health. 2024 Feb 13;23(1):28. doi: 10.1186/s12939-024-02118-2.
Despite considerable investment in maternal-child programs in Canada, there has been little positive impact on the health of Indigenous mothers and their children. The reasons for this are unclear and there is a need to identify how such programs can be successfully implemented. Community input is essential for successful programs; however, it is unclear what the contributions of frontline workers have been in the health program process, i.e., program development, delivery, and evaluation. Based on these identified gaps, this scoping review aimed to: (1) identify factors of success and barriers to successful Indigenous maternal-child community health programs for mothers and their children aged 0-6 years; and (2) explore how frontline workers are included in the program process.
This scoping review was completed using the Arksey and O'Malley framework, informed by Levac et al. Four data bases (Medline, CINAHL, Embase, and Scopus), grey literature, and reference lists were searched for relevant materials from 1990-2019. Data was extracted from included articles and analysed using descriptive statistics, thematic analysis with the Braun and Clarke framework, and a Principal Component Analysis.
Forty-five peer-reviewed and grey articles were included in the review. Factors of program success included: relationship building; cultural inclusion; knowledge transmission styles; community collaboration; client-centred approaches; Indigenous staff; and operational considerations. Barriers included: impacts of colonization; power structure and governance; client and community barriers to program access; physical and geographical challenges; lack of staff; and operational deficits. Frontline workers were found to have a role in program delivery (n = 45) and development (n = 25). Few (n = 6) had a role in program evaluation.
Although a better understanding of the frontline worker role in maternal-child health programs was obtained from the review, in a large proportion of literature the authors could not determine if the role went beyond program delivery. In addition, no direct input from frontline workers and their perspectives on program success or barriers were identified, suggesting areas to explore in future research. This review's findings have been applied to inform a community-based participatory research project and may also help improve the development, delivery, and evaluation of Indigenous maternal-child health programs.
尽管加拿大在母婴项目上投入了大量资金，但对土著母亲及其子女的健康却几乎没有产生积极影响。其原因尚不清楚，因此需要确定如何成功实施此类项目。社区投入对于成功的项目至关重要；然而，目前尚不清楚一线工作人员在健康项目的规划、实施和评估过程中做出了哪些贡献。基于这些已确定的差距，本范围综述旨在：(1) 确定成功的因素和障碍，以实现针对 0-6 岁土著母婴社区健康计划；(2) 探讨一线工作人员如何参与该计划过程。
本范围综述是根据 Arksey 和 O'Malley 框架，并借鉴 Levac 等人的方法，利用 Medline、CINAHL、Embase 和 Scopus 这四个数据库、灰色文献和参考文献列表，对 1990 年至 2019 年的相关材料进行了检索。从纳入的文章中提取数据，并使用描述性统计、基于 Braun 和 Clarke 框架的主题分析以及主成分分析进行分析。
本综述共纳入 45 篇同行评议和灰色文献。方案成功的因素包括：建立关系；文化包容；知识传递方式；社区合作；以客户为中心的方法；土著工作人员；以及运营考虑因素。障碍包括：殖民化的影响；权力结构和治理；客户和社区对项目的阻碍；身体和地理方面的挑战；缺乏工作人员；以及运营缺陷。一线工作人员在方案实施(n=45)和开发(n=25)方面发挥了作用。在很少的情况下(n=6)，他们在方案评估方面发挥了作用。
尽管通过本次综述对一线工作人员在母婴健康项目中的作用有了更好的了解，但在很大一部分文献中，作者无法确定他们的角色是否超出了方案的实施。此外，没有直接从一线工作人员那里获得他们对方案成功或障碍的看法，这表明在未来的研究中需要探索这些方面。本综述的研究结果已应用于一个基于社区的参与式研究项目，并可能有助于改善土著母婴健康计划的制定、实施和评估。
