Campbell, S., McCalman, J., Redman-MacLaren, M., Canuto, K., Vine, K., Sewter, J., & McDonald, M. (2018). Implementing the Baby One Program: a qualitative evaluation of family-centred child health promotion in remote Australian Aboriginal communities. BMC Pregnancy and Childbirth, 18(1), 73. Retrieved from https://doi.org/10.1186/s12884-018-1711-7.
Remote-living Aboriginal and Torres Strait Islander Australian families experience a high rate of maternal and neonatal morbidity and mortality compared to the non-Indigenous population. This article describes a qualitative formative implementation outcome evaluation of The Baby One Program (BOP), a family-centered, Indigenous Healthworker-led, home-visiting model. The BOP was developed by the Aboriginal community-controlled Apunipima Health Council to address the lack of access to culturally-safe health services for these Indigenous families. During this study, Indigenous Healthworkers were collaborating with midwives and maternal and child health nurses to deliver health education to a total of 161 eligible families in nine remote communities. Using theoretical and purposive sampling, the researchers conducted semi-structured interviews and one focus group with 24 Apunipima staff members. Interviews were conducted with BOP service recipients (two mothers and a couple). Focus groups with 20 men were held in one community, including two men whose families participated in the program.
Evaluation results using a thematic analysis approach indicated the program was meeting its goals, with 100% uptake by the families invited to participate. The researchers identified eight themes that described the community context and program challenges and successes. Key to successful program implementation were the relationships among Indigenous Healthworkers, midwives, and nurses, and particularly between Indigenous Healthworkers and families. The use of Indigenous knowledge throughout the program and the training and support provided Indigenous Healthworkers were also important to the effectiveness of the program. Final recommendations from the authors were to: (1) engage communities at multiple levels, including elders and councils; (2) address the needs of the entire family, rather than focusing on mothers and babies; and (3) imbed formal program evaluation strategies, including outcome indicators, systematic data collection, and regular family engagement and satisfaction measures.
The limited ability of the researchers to travel to remote communities, given time and funding constraints, was the main challenge for this formative evaluation. Consequently, only four out of 161 BOP participants were interviewed by the English-speaking researchers when they traveled to the nearest hospital in Cairns to give birth. Likewise, the men’s focus groups were limited to one out of nine communities. Although the researchers had planned to interview more recipients, they felt that data saturation was reached with the range of interviews conducted, particularly with the participatory and iterative approach used throughout the evaluation process. Despite this limitation, the authors provide a transparent description of the challenges and successes of the evaluation process, and document successful strategies for implementing Indigenous-led family-centered programs. Learning from such efforts is crucial for the effective development, implementation, and evaluation of a range of services to Indigenous families and communities.