Jennifer Knight

Initiation and duration of breastfeeding in an Aboriginal community in South Western Sydney

The Gudaga Study is a prospective, longitudinal birth cohort study of Australian urban Aboriginal children. Mothers of Aboriginal infants were recruited using a survey of all mothers admitted to the maternity ward of an outer urban hospital in Sydney. These data established initiation rates among Gudaga infants and those of non-Aboriginal infants born locally (64.7% and 75.2%, respectively) and factors associated with breastfeeding. Older (relative risk, 1.24; confidence interval, 1.01-1.44), more educated (relative risk, 1.30; confidence interval, 1.11-1.48) mothers who intended to breastfeed (relative risk, 2.22; confidence interval, 2.12-2.3) were more likely to breastfeed. Smokers (relative risk, 0.72) and mothers of Aboriginal infants (relative risk, 0.78) were less likely to initiate breastfeeding. Breastfeeding rates for Gudaga infants dropped rapidly, with 26.3% breastfeeding at 2 months. Local health services providers can benefit from such information as they target relevant prenatal, perinatal, and postnatal services for Aboriginal mothers and their infants.

Describing the growth and rapid weight gain of urban Australian Aboriginal infants

The aims of this paper are to describe the growth of urban Australian Aboriginal infants from birth to 24 months of age and to identify the proportion of these infants experiencing rapid weight gain (RWG) and overweight/obesity.

Developmental progress in urban Aboriginal infants: A cohort study

Aim:  To measure, describe and investigate potential predictors of early developmental progress in urban Aboriginal infants.

The Gudaga Study: Development in 3-year-old urban Aboriginal children

The aim of this analysis was to study and explore factors associated with the developmental progress in urban Aboriginal children at 3 years.

Timeliness of antenatal care for mothers of Aboriginal and non-Aboriginal infants in an urban setting

To compare the timing of first hospital antenatal care visit by mothers of Aboriginal and non-Aboriginal infants, and to identify the risk and protective factors associated with timeliness of accessing care, mothers who delivered at Campbelltown hospital between October 2005 and November 2006 were surveyed on the maternity ward. This survey was linked to hospital administrative data. Gestational age at first visit to a hospital-based antenatal clinic was compared for mothers of Aboriginal and non-Aboriginal infants. Risks and protective factors associated with timing of antenatal care were also examined using Cox regression and Kaplan-Meier survival curves. Data on 1520 deliveries were included in this study. Mothers of Aboriginal infants presented slightly later to hospital-based antenatal clinics than mothers of non-Aboriginal infants (median 15.6 weeks versus 14.0 weeks). This difference did not remain after adjustment for all risk and protective factors. The three significant factors remaining were: maternal smoking; not in paid employment; and residence in a disadvantaged suburb. The results may reflect the complex associations that exist between the clustering of disadvantage among families of Aboriginal infants. A multifaceted approach is required to improve the timeliness of hospital-based antenatal care for the mothers of Aboriginal infants.

The use of a standardized language assessment tool to measure the language development of urban Aboriginal preschoolers

Abstract The use of standardized language assessment tools with Australian Indigenous children has been criticized for language and cultural reasons; however, this has not been tested in an urban context. The aim of the study was to explore the language performance of a small sample of urban Aboriginal preschoolers on a standardized language tool compared with a conversational sample. Fifteen participants (drawn from a birth cohort study of over 150 Aboriginal infants born at a metropolitan hospital) completed the Clinical Evaluation of Language Fundamentals–Preschool Edition, Second Edition (CELF-P2) and generated a 30-minute conversational language sample. Descriptive data are reported, and five case studies are explored in detail to compare results of the CELF-P2 and the language sample analysis. Grammatical features of Aboriginal English are also investigated. There was a diverse range of responses to standardized assessment and language sampling, with some samples reflective of CELF-P2 results. Two or more grammatical features of Aboriginal English were identified in 13 of the language samples. The results suggest the CELF-P2 is an appropriate tool to use to assess the language development of the children in the study when used in conjunction with analysis of language samples obtained using culturally appropriate methods.

Universal for whom? Evaluating an urban Aboriginal population's access to a mainstream universal health home visiting program

OBJECTIVE To investigate access to a Universal Health Home Visit program for families of Aboriginal and non-Aboriginal infants and the effect of a one-off home visit on subsequent health service utilisation. METHODS A case-control study was undertaken drawing 175 Aboriginal infants from an Aboriginal birth cohort study and 352 matched non-Aboriginal infants. A structured file audit extracted data from child and family health nurse records. Receipt of home visit and effect on ongoing use of child and family nurses services was compared for Aboriginal and non-Aboriginal infants. RESULTS Of the 527 infants, 279 (53.0%) were visited at home within 2 weeks. This is below NSW Health benchmarks. Significantly fewer Aboriginal infants (42.9%) compared to non-Aboriginal infants (58.0%) received a home visit within 2 weeks (P<0.01). Receipt of a single home visit did not affect future service use or the number of child health checks infants received. CONCLUSION This study highlights the challenges of ensuring equitable access to a universal post-natal home visiting program. Assessing ways in which universal services are delivered to ensure equity of access may help to re-evaluate target expectations, reduce demand on nursing staff, improve targeting of vulnerable infants and help in further developing and implementing effective health policy.

The Gudaga Research Program: A Case Study in Undertaking Research with an Urban Aboriginal Community

ABSTRACT This paper presents the Gudaga Research Program as a case study describing the practice principles used to implement a successful research partnership with an urban Aboriginal community in south-western Sydney. This is one of few papers that address research issues unique to working with urban Aboriginal communities, in which the Aboriginal culture of the community is not homogenous. The authors argue that the relationships between the researchers and key community members and research participants underpin the research success. Throughout, the authors show that ongoing processes to nurture and reaffirm these relationships are important and require ongoing investment. A proposed practice framework demonstrates the relationship between knowledge and understanding of Aboriginal history and culture, the underpinning values including trust, respect, and reciprocity, and shared skills and communication. Examples of how these were built into the research are provided. These are important skills that have application beyond the research process.

Gudaga goes to school study: methods used in understanding school transitions and early education experiences of an urban Aboriginal cohort

Abstract The Gudaga Goes to School Study described the transition to school and early education experiences of 117 urban Aboriginal children and their families. This paper outlines the methods and design of the study. A life course approach, employing multidimensional and multi-theoretical frameworks was used to capture the complexity of issues surrounding the transition and early school experiences with multi-methods used to collect data from children, parents and teachers. Quantitative data included questionnaires, checklists and educational assessments to track children’s academic progress, school attendance, and social/emotional/behavioural development. Qualitative data consisted of semi-structured interviews and focus groups to gain the perspective of stakeholders. Children also participated using photography and drawing mediums. The community controlled study was conceived, designed and conducted in close consultation with the local Aboriginal community.

Community Volunteer Support for Families With Young Children: Protocol for the Volunteer Family Connect Randomized Controlled Trial

Background Use of community volunteers to support vulnerable families is a widely employed strategy with a long history. However, there has been minimal formal scientific investigation into the effectiveness of volunteer home visiting programs for families. There is also a need for research examining whether volunteer home visiting leads to improved outcomes for volunteers. Objective The objective of this paper is to describe the research protocol for a pragmatic randomized controlled trial (RCT) of the Volunteer Family Connect intervention, a volunteer home visiting program designed to support families of young children who experience social isolation or a lack of parenting confidence and skills. The project is being conducted in partnership with 3 leading not-for-profit organizations, designed to contribute to the body of evidence that informs decisions about appropriate family support services according to the level of need. It is the first study to examine outcomes for both the families and the volunteers who deliver the service. Methods The RCT is being conducted in 7 sites across Australia. We aim to recruit 300 families to the study: 150 control (services as usual) and 150 intervention (services as usual + volunteer home visiting) families. Intervention families will receive the service for 3-12 months according to their needs, and all participants will complete 6 data collection points over 15 months. A minimum of 80 volunteers will also be recruited, along with a matched community comparison group. The volunteers will complete 3 data collection points over 12 months. Primary outcomes include community connectedness and parenting competence. Secondary outcomes include parent physical and mental health; general parent well-being; parent empowerment; the child-parent relationship; sustainability of family routines; child immunization; child nutrition or breastfeeding; number of accidental injury reports; and volunteer health, well-being, and community connectedness. Results This effectiveness trial was funded in 2016, and we aim to complete data collection by the end of 2018. The first results are expected to be submitted early in 2019. Conclusions There is a need to rigorously assess volunteer home visiting and whether it has a unique and important role on the service landscape, complementary to professional services. This research is the first trial of a volunteer home visiting program to be conducted in Australia and one of the largest of its kind worldwide. Trial Registration Australian New Zealand Clinical Trial Registry ACTRN12616000396426; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370304 (Archived by WebCite athttp://www.webcitation.org/70q42fU7V) Registered Report Identifier RR1-10.2196/1000