Roz Walker

Facilitating empowerment and self-determination through participatory action research: findings from the National Empowerment Project

The National Empowerment Project (NEP) is an innovative Aboriginal-led community-based project. Since 2012, it has been working with communities in 11 sites across Australia to develop a culturally appropriate health promotion and primary prevention intervention strategy to reduce the high rates of psychological distress and suicide among Aboriginal and Torres Strait Islander peoples. The NEP is built around the use of localized participatory action research (PAR) processes to support communities to identify key factors negatively impacting on their lives as well as strategies for promoting well-being and building resilience. This article details the application of the PAR approach by the NEP Aboriginal community-based researchers. It provides some unique insights into how PAR facilitated communities to have a voice and the ways in which it supported important change processes at both an individual and a community level.

Using participatory action research to prevent suicide in Aboriginal and Torres Strait Islander communities

The National Empowerment Project is an innovative Aboriginal-led community empowerment project that has worked with eight Aboriginal and Torres Strait Islander communities across Australia over the period 2012-13. The aim of the Project was to develop, deliver and evaluate a program to: (1) promote positive social and emotional well-being to increase resilience and reduce the high reported rates of psychological distress and suicide among Aboriginal and Torres Strait Islander people; and (2) empower communities to take action to address the social determinants that contribute to psychological distress, suicide and self-harm. Using a participatory action research approach, the communities were supported to identify the risk factors challenging individuals, families and communities, as well as strategies to strengthen protective factors against these challenges. Data gathered during Stage 1 were used to develop a 12-month program to promote social and emotional well-being and build resilience within each community. A common framework, based on the social and emotional well-being concept, was used to support each community to target community-identified protective factors and strategies to strengthen individual, family and community social and emotional well-being. Strengthening the role of culture is critical to this approach and marks an important difference between Aboriginal and Torres Strait Islander and non-Indigenous mental health promotion and prevention activities, including suicide prevention. It has significant implications for policy makers and service providers and is showing positive impact through the translation of research into practice, for example through the development of a locally run empowerment program that aims to address the social determinants of health and their ongoing negative impact on individuals, families and communities. It also provides a framework in which to develop and strengthen culture, connectedness and foster self-determination, through better-informed policy based on community-level holistic responses and solutions as opposed to an exclusive focus on single-issue deficit approaches.

Peer-led Aboriginal parent support: Program development for vulnerable populations with participatory action research

Background: Participatory action research (PAR) is a credible, culturally appropriate methodology that can be used to effect collaborative change within vulnerable populations. Aim/objective: This PAR study was undertaken in a Western Australian metropolitan setting to develop and evaluate the suitability, feasibility and effectiveness of an Aboriginal peer-led home visiting programme. A secondary aim, addressed in this paper, was to explore and describe research methodology used for the study and provide recommendations for its implementation in other similar situations. Methods: PAR using action learning sets was employed to develop the parent support programme and data addressing the secondary, methodological aim were collected through focus groups using semi-structured and unstructured interview schedules. Findings were addressed throughout the action research process to enhance the research process. Results: The themes that emerged from the data and addressed the methodological aim were the need for safe communication processes; supportive engagement processes and supportive organisational processes. Conclusions: Aboriginal peer support workers (PSWs) and community support agencies identified three important elements central to their capacity to engage and work within the PAR methodology. This research has provided innovative data, highlighting processes and recommendations for child health nurses to engage with the PSWs, parents and community agencies to explore culturally acceptable elements for an empowering methodology for peer-led home visiting support. There is potential for this nursing research to credibly inform policy development for Aboriginal child and family health service delivery, in addition to other vulnerable population groups. Child health nurses/researchers can use these new understandings to work in partnership with Aboriginal communities and families to develop empowering and culturally acceptable strategies for developing Aboriginal parent support for the early years. Impact Statement Child health nurses and Aboriginal communities can collaborate through participatory action research to develop peer-led support for the early years. Indigenous Australian peoples are people who identify as Aboriginal or Torres Strait Islander. Respectfully, throughout this paper, they will be described as Aboriginal.

A systematic review of the evidence that swimming pools improve health and wellbeing in remote Aboriginal communities in Australia

Objective: To provide an overview of the evidence for health and wellbeing benefits associated with swimming pools in remote Aboriginal* communities in Australia.

Community learning for parenthood

In addition to the obvious benefits of early child development for improving the life-chances of individual children, the promotion of early human development is increasingly recognised as benefiting communities and society through longer-term gains in population health, educational outcomes and opportunities for social, civic and economic participation. Given the strength of research evidence regarding the importance of the early years for children’s subsequent health, learning and behaviour – as well as for their longer-term adult health and wellbeing – there is now an imperative to make sure that this knowledge is widely available to parents and the general community. The roll-out of new national and state policies and programs for early child development has enabled many communities around the Australia to implement exciting examples of innovative practice. However, the longer-term sustainability of these initiatives will require investment in work-force development, pre- and in-service training to improve understanding of the processes of early child development, and skills training in new ways of working based on evidence of ‘what works’ in strengths focused child and family community development, population health interventions, child-care and education. The new knowledge of experience-based human development and how gene expression is now understood to be regulated by the environment during the early years of brain development has brought new insights into which experiences and which aspects of children’s family and community environments of child rearing matter most for children’s trajectories of health and competence. The paper concludes with a discussion of how these new perspectives on early human development can be disseminated and used to increase broader community awareness and understanding of the vital role of parenting, child health, care and education. It considers the range of new strategies needed to support community learning for parenthood, including strategies which are inclusive of the needs of parents and children from Indigenous and other culturally and linguistically diverse backgrounds.

Early Vocabulary Development of Australian Indigenous Children: Identifying Strengths

The current study sought to increase our understanding of the factors involved in the early vocabulary development of Australian Indigenous children. Data from the Longitudinal Study of Indigenous Children were available for 573 Indigenous children (291 boys) who spoke English ( months, months, at wave 3). Data were also available for 86 children (51 boys) who spoke an Indigenous language ( months, months, at wave 3). As hypothesised, higher levels of parent-child book reading and having more children’s books in the home were associated with better English vocabulary development. Oral storytelling in Indigenous language was a significant predictor of the size of children’s Indigenous vocabulary.

Decolonising Psychology: Validating Social and Emotional Wellbeing

Objective Australian Aboriginal and Torres Strait Islander social and emotional wellbeing (SEWB) is a multifaceted concept that acknowledges that a persons wellbeing is determined by a range of inter‐related domains: body, mind and emotions, family and kinship, community, culture, Country, and spirituality. This paper explores the meaning of these seven domains of SEWB. Method A thematic analysis of qualitative data obtained from the National Empowerment Project (NEP) was conducted, along with a literature review of each domain. Results Findings from the NEP, together with relevant literature, indicate that implementing strategies that focus on strengthening SEWB is important for individual, family, and community wellbeing. Addressing the social determinants of Indigenous disadvantage is also shown to have an important role in strengthening the SEWB of individuals, families, and communities. Conclusion It is important for all practitioners and policymakers involved with improving Indigenous health to recognise the seven inter‐related domains of SEWB and to acknowledge and support people in addressing the social determinants of wellbeing.

Hospital admissions for skin infections among Western Australian children and adolescents from 1996 to 2012

The objective of this study was to describe the occurrence of skin infection associated hospitalizations in children born in Western Australia (WA). We conducted a retrospective cohort study of all children born in WA between 1996 and 2012 (n = 469,589). Of these, 31,348 (6.7%) were Aboriginal and 240,237 (51.2%) were boys. We report the annual age-specific hospital admission rates by geographical location and diagnostic category. We applied log-linear regression modelling to analyse changes in temporal trends of hospitalizations. Hospitalization rates for skin infections in Aboriginal children (31.7/1000 child-years; 95% confidence interval [CI] 31.0–32.4) were 15.0 times higher (95% CI 14.5–15.5; P<0.001) than those of non-Aboriginal children (2.1/1000 child-years; 95% CI 2.0–2.1). Most admissions in Aboriginal children were due to abscess, cellulitis and scabies (84.3%), while impetigo and pyoderma were the predominant causes in non-Aboriginal children (97.7%). Admissions declined with age, with the highest rates for all skin infections observed in infants. Admissions increased with remoteness. Multiple admissions were more common in Aboriginal children. Excess admissions in Aboriginal children were observed during the wet season in the Kimberley and during summer in metropolitan areas. Our study findings show that skin infections are a significant cause of severe disease, requiring hospitalization in Western Australian children, with Aboriginal children at a particularly high risk. Improved community-level prevention of skin infections and the provision of effective primary care are crucial in reducing the burden of skin infection associated hospitalizations. The contribution of sociodemographic and environmental risk factors warrant further investigation.

Effectiveness and experiences of families and support workers participating in peer-led parenting support programs delivered as home visiting programs: a comprehensive systematic review

Background Designing child and family health services to meet the diverse needs of contemporary families is intended to minimize impacts of early disadvantage and subsequent lifelong health and social issues. Innovative programs to engage families with child and family support services have led to interest in the potential value of peer-led home visiting from parents in local communities. There is a range of benefits and challenges identified in a limited number of studies associated with home visiting peer support. Objectives The objective of the review is to identify: The effectiveness of peer-led parenting support programs delivered as home visiting programs to indigenous and non-indigenous families and the characteristics of successful programs. The experiences of families and support workers participating in parenting support programs delivered as home visiting programs including the relationships between the program participants. Inclusion criteria Participants Families/parents with one or more children aged zero to four years, peer support workers and their supervisors. Intervention and phenomenon of interest Peer-led home visiting parenting support programs that use volunteer or paraprofessional home visitors from the local community compared to standard community maternal-child care. The phenomenon of interest will be the relationships between participants in the program. Types of studies Quantitative studies: randomized control trials (RCTs). Qualitative studies: grounded theory and qualitative descriptive studies. Outcomes Parental attitudes and beliefs, coping skills and confidence in parenting, parental stress, compliance with child health checks/links with primary healthcare services, satisfaction with peer support and services and the nature of the relationship between parents and home visitors. Search strategy The search strategy will include both published and unpublished studies. Seven journal databases and five other sources will be searched. Only studies published in the English language from 2000 to 2015 will be considered. Methodological quality Studies were assessed by two independent reviewers using standardized critical appraisal tools from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) and the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) as appropriate. Data extraction Both quantitative and qualitative data were independently extracted by two reviewers using standardized data extraction tools from the JBI-MAStARI and the JBI-QARI, respectively, including qualitative and quantitative details about setting of interventions, phenomena of interest, participants, study methods and outcomes or findings. Data synthesis For quantitative findings, statistical pooling was not possible due to differences in interventions and outcome measures. Findings were presented in narrative form. Qualitative findings were aggregated into categories based on similarity of meaning from which synthesized findings were generated. Results Quantitative results from two RCTs demonstrated positive impacts of peer-led home visiting parent support programs including more positive parenting attitudes and beliefs, and more child preventative health care visits. Fifteen qualitative findings from two studies were aggregated into five categories from which two synthesized findings emerged. Parents and home visitors identified similar components as contributing to their programs success, these being quality of relationships between parents and home visitors with elements being mutual respect, trust and being valued within the partnership. In addition, home visitors identified importance of enabling strategies to develop relationships. They also needed supportive working environments with clinical staff and management. Conclusion The current review indicates a positive impact of peer-led home visiting parent support programs, incorporating a framework of partnership between parents and home visitors, on mother-infant dyads. Positive changes in parenting attitudes and beliefs, and increased number of child preventative healthcare visits are supported by the quality of the relationship between parent and home visitor, and home visitors’ working environments. Implications for practice The essential characteristics of an effective parent support program are strategies for relationship building between parents and home visitors; ongoing staff and home visitor education to enhance communication, collaboration and working in partnership; supervision by team leaders; and continuous quality improvement. Implications for research The focus of further research should be on confirmatory studies using an action research methodology and the cost-effectiveness of these models.

Ascertaining infectious disease burden through primary care clinic attendance among young Aboriginal children living in four remote communities in Western Australia

Infectious diseases contribute a substantial burden of ill-health in Australia’s Aboriginal children. Skin infections have been shown to be common in remote Aboriginal communities, particularly in the Northern Territory, Australia. However, primary care data on skin and other infectious diseases among Aboriginal children living in remote areas of Western Australia are limited. We conducted a retrospective review of clinic presentations of all children aged 0 to 5 years presenting to four clinics located in the Western Desert region of Western Australia between 2007 and 2012 to determine this burden at a local level. Infectious diseases accounted for almost 50% of all clinic presentations. Skin infections (sores, scabies and fungal infections) were the largest proportion (16%), with ear infections (15%) and upper respiratory infections (13%) also high. Skin infections remained high in all age groups; 72% of children presented at least once with skin infections. Scabies accounted for only 2% of all presentations, although one-quarter of children presented during the study for management of scabies. Skin sores accounted for 75% of the overall burden of skin infections. Improved public health measures targeting bacterial skin infections are needed to reduce this high burden of skin infections in Western Australia.