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Strobel NA, Chamberlain C, Campbell SK, Shields L, Bainbridge RG, Adams C, Edmond KM, Marriott R, McCalman J. Family-centred interventions for Indigenous early childhood well-being by primary healthcare services. Cochrane Database Syst Rev 2022; 12:CD012463. [PMID: 36511823 PMCID: PMC9746601 DOI: 10.1002/14651858.cd012463.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Primary healthcare, particularly Indigenous-led services, are well placed to deliver services that reflect the needs of Indigenous children and their families. Important characteristics identified by families for primary health care include services that support families, accommodate sociocultural needs, recognise extended family child-rearing practices, and Indigenous ways of knowing and doing business. Indigenous family-centred care interventions have been developed and implemented within primary healthcare services to plan, implement, and support the care of children, immediate and extended family and the home environment. The delivery of family-centred interventions can be through environmental, communication, educational, counselling, and family support approaches. OBJECTIVES To evaluate the benefits and harms of family-centred interventions delivered by primary healthcare services in Canada, Australia, New Zealand, and the USA on a range of physical, psychosocial, and behavioural outcomes of Indigenous children (aged from conception to less than five years), parents, and families. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 22 September 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs, controlled before-after studies, and interrupted time series of family-centred care interventions that included Indigenous children aged less than five years from Canada, Australia, New Zealand, and the USA. Interventions were included if they met the assessment criteria for family-centred interventions and were delivered in primary health care. Comparison interventions could include usual maternal and child health care or one form of family-centred intervention versus another. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. overall health and well-being, 2. psychological health and emotional behaviour of children, 3. physical health and developmental health outcomes of children, 4. family health-enhancing lifestyle or behaviour outcomes, 5. psychological health of parent/carer. 6. adverse events or harms. Our secondary outcomes were 7. parenting knowledge and awareness, 8. family evaluation of care, 9. service access and utilisation, 10. family-centredness of consultation processes, and 11. economic costs and outcomes associated with the interventions. We used GRADE to assess the certainty of the evidence for our primary outcomes. MAIN RESULTS We included nine RCTs and two cluster-RCTs that investigated the effect of family-centred care interventions delivered by primary healthcare services for Indigenous early child well-being. There were 1270 mother-child dyads and 1924 children aged less than five years recruited. Seven studies were from the USA, two from New Zealand, one from Canada, and one delivered in both Australia and New Zealand. The focus of interventions varied and included three studies focused on early childhood caries; three on childhood obesity; two on child behavioural problems; and one each on negative parenting patterns, child acute respiratory illness, and sudden unexpected death in infancy. Family-centred education was the most common type of intervention delivered. Three studies compared family-centred care to usual care and seven studies provided some 'minimal' intervention to families such as education in the form of pamphlets or newsletters. One study provided a minimal intervention during the child's first 24 months and then the family-centred care intervention for one year. No studies had low or unclear risk of bias across all domains. All studies had a high risk of bias for the blinding of participants and personnel domain. Family-centred care may improve overall health and well-being of Indigenous children and their families, but the evidence was very uncertain. The pooled effect estimate from 11 studies suggests that family-centred care improved the overall health and well-being of Indigenous children and their families compared no family-centred care (standardised mean difference (SMD) 0.14, 95% confidence interval (CI) 0.03 to 0.24; 2386 participants). We are very uncertain whether family-centred care compared to no family-centred care improves the psychological health and emotional behaviour of children as measured by the Infant Toddler Social Emotional Assessment (ITSEA) (Competence domain) (mean difference (MD) 0.04, 95% CI -0.03 to 0.11; 2 studies, 384 participants). We assessed the evidence as being very uncertain about the effect of family-centred care on physical health and developmental health outcomes of children. Pooled data from eight trials on physical health and developmental outcomes found there was little to no difference between the intervention and the control groups (SMD 0.13, 95% CI -0.00 to 0.26; 1961 participants). The evidence is also very unclear whether family-centred care improved family-enhancing lifestyle and behaviours outcomes. Nine studies measured family health-enhancing lifestyle and behaviours and pooled analysis found there was little to no difference between groups (SMD 0.16, 95% CI -0.06 to 0.39; 1969 participants; very low-certainty evidence). There was very low-certainty evidence of little to no difference for the psychological health of parents and carers when they participated in family-centred care compared to any control group (SMD 0.10, 95% CI -0.03 to 0.22; 5 studies, 975 parents/carers). Two studies stated that there were no adverse events as a result of the intervention. No additional data were provided. No studies reported from the health service providers perspective or on outcomes for family's evaluation of care or family-centredness of consultation processes. AUTHORS' CONCLUSIONS There is some evidence to suggest that family-centred care delivered by primary healthcare services improves the overall health and well-being of Indigenous children, parents, and families. However, due to lack of data, there was not enough evidence to determine whether specific outcomes such as child health and development improved as a result of family-centred interventions. Seven of the 11 studies delivered family-centred education interventions. Seven studies were from the USA and centred on two particular trials, the 'Healthy Children, Strong Families' and 'Family Spirit' trials. As the evidence is very low certainty for all outcomes, further high-quality trials are needed to provide robust evidence for the use of family-centred care interventions for Indigenous children aged less than five years.
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Affiliation(s)
- Natalie A Strobel
- Kurongkurl Katitjin, Edith Cowan University, Mount Lawley, Australia
- Medical School, The University of Western Australia, Perth, Australia
| | - Catherine Chamberlain
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Sandra K Campbell
- College of Nursing & Midwifery, Charles Darwin University, Darwin, Australia
| | - Linda Shields
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Roxanne G Bainbridge
- School of Human Health and Social Sciences, Central Queensland University, Cairns, Australia
| | - Claire Adams
- Kurongkurl Katitjin, Edith Cowan University, Mount Lawley, Australia
| | - Karen M Edmond
- Department of Women and Children's Health, King's College London, London, UK
| | - Rhonda Marriott
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Murdoch, Australia
| | - Janya McCalman
- School of Human Health and Social Sciences, Central Queensland University, Cairns, Australia
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Reweti A, Severinsen C. Waka ama: An exemplar of indigenous health promotion in Aotearoa New Zealand. Health Promot J Austr 2022; 33 Suppl 1:246-254. [PMID: 35714045 PMCID: PMC9796799 DOI: 10.1002/hpja.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 01/07/2023] Open
Abstract
ISSUE ADDRESSED The use of old-style, top-down health education and awareness programmes in Aotearoa New Zealand, which adopt a single issue-based approach to health promotion, primarily ignores a broad approach to social determinants of health, as well as indigenous Māori understandings of wellbeing. METHODS This paper draws on the indigenous framework Te Pae Māhutonga as a guide for presenting narratives collated from members of a waka ama rōpū (group) who were interviewed about the social, cultural and health benefits of waka ama. RESULTS This waka ama case study is an exemplar of community-led health promotion within an indigenous context, where Māori values and practices, such as whanaungatanga (the process of forming and maintaining relationships), manaakitanga (generosity and caring for others) and kaitiakitanga (guardianship), are foundational. The findings highlight the multiple benefits of engagement in waka ama and illustrate effective techniques for enhancing wellbeing within local communities. CONCLUSION At a time when Aotearoa New Zealand is seeing a decreasing trend in physical activity levels and an increase in mental health challenges, waka ama provides us with an exemplar of ways to increase health and wellbeing within our communities. SO WHAT?: The findings of this research contribute to the evidence base of effective indigenous health promotion, bridging the gap between academia and local community action. To better recognise, comprehend and improve indigenous health and wellbeing, we argue that active participation of people in the community is required to achieve long-term and revolutionary change.
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Maddison R, Baghaei N, Calder A, Murphy R, Parag V, Heke I, Dobson R, Marsh S. Feasibility of Using Games to Improve Healthy Lifestyle Knowledge in Youth Aged 9-16 Years at Risk for Type 2 Diabetes: Pilot Randomized Controlled Trial. JMIR Form Res 2022; 6:e33089. [PMID: 35713955 PMCID: PMC9250061 DOI: 10.2196/33089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Mobile games can be effective and motivating tools for promoting children’s health.
Objective
We aimed to determine the comparative use of 2 prototype serious games for health and assess their effects on healthy lifestyle knowledge in youth aged 9-16 years at risk for type 2 diabetes (T2D).
Methods
A 3-arm parallel pilot randomized controlled trial was undertaken to determine the feasibility and preliminary effectiveness of 2 serious games. Feasibility aspects included recruitment, participant attitudes toward the games, the amount of time the participants played each game at home, and the effects of the games on healthy lifestyle and T2D knowledge. Participants were allocated to play Diabetic Jumper (n=7), Ari and Friends (n=8), or a control game (n=8). All participants completed healthy lifestyle and T2D knowledge questionnaires at baseline, immediately after game play, and 4 weeks after game play. Game attitudes and preferences were also assessed. The primary outcome was the use of the game (specifically, the number of minutes played over 4 weeks).
Results
In terms of feasibility, we were unable to recruit our target of 60 participants. In total, 23 participants were recruited. Participants generally viewed the games positively. There were no statistical differences in healthy lifestyle knowledge or diabetes knowledge over time or across games. Only 1 participant accessed the game for an extended period, playing the game for a total of 33 min over 4 weeks.
Conclusions
It was not feasible to recruit the target sample for this trial. The 2 prototype serious games were unsuccessful at sustaining long-term game play outside a clinic environment. Based on positive participant attitudes toward the games, it is possible to use these games or similar games as short-term stimuli to engage young people with healthy lifestyle and diabetes knowledge in a clinic setting; however, future research is required to explore this area.
Trial Registration
Australia New Zealand Clinical Trials Registry ACTRN12619000380190; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377123
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Affiliation(s)
- Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Nilufar Baghaei
- Games and Extended Reality Lab, Massey University, Auckland, New Zealand
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Amanda Calder
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Rinki Murphy
- Department of Medicine, Middlemore Hospital, University of Auckland, Auckland, New Zealand
| | - Varsha Parag
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | | | - Rosie Dobson
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Samantha Marsh
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
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Chando S, Howell M, Young C, Craig JC, Eades SJ, Dickson M, Howard K. Outcomes reported in evaluations of programs designed to improve health in Indigenous people. Health Serv Res 2021; 56:1114-1125. [PMID: 33748978 PMCID: PMC8586489 DOI: 10.1111/1475-6773.13653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the outcomes reported and measured in evaluations of complex health interventions in Indigenous communities. DATA SOURCES We searched all publications indexed in MEDLINE, PreMEDLINE, EMBASE, PsycINFO, EconLit, and CINAHL until January 2020 and reference lists from included papers were hand-searched for additional articles. STUDY DESIGN Systematic review. DATA COLLECTION/EXTRACTION METHODS We included all primary studies, published in peer-reviewed journals, where the main objective was to evaluate a complex health intervention developed specifically for an Indigenous community residing in a high-income country. Only studies published in English were included. Quantitative and qualitative data were extracted and summarized. PRINCIPAL FINDINGS Of the 3523 publications retrieved, 62 evaluation studies were included from Australia, the United States, Canada, and New Zealand. Most studies involved less than 100 participants and were mainly adults. We identified outcomes across 13 domains: clinical, behavioral, process-related, economic, quality of life, knowledge/awareness, social, empowerment, access, environmental, attitude, trust, and community. Evaluations using quantitative methods primarily measured outcomes from the clinical and behavioral domains, while the outcomes reported in the qualitative studies were mostly from the process-related and empowerment domains. CONCLUSION The outcomes from qualitative evaluations, which better reflect the impact of the intervention on participant health, remain different from the outcomes routinely measured in quantitative evaluations. Measuring the outcomes from qualitative evaluations alongside outcomes from quantitative evaluations could result in more relevant evaluations to inform decision making in Indigenous health.
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Affiliation(s)
- Shingisai Chando
- University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Martin Howell
- University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia
| | | | - Jonathan C. Craig
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
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Chando S, Tong A, Howell M, Dickson M, Craig JC, DeLacy J, Eades SJ, Howard K. Stakeholder perspectives on the implementation and impact of Indigenous health interventions: A systematic review of qualitative studies. Health Expect 2021; 24:731-743. [PMID: 33729648 PMCID: PMC8235882 DOI: 10.1111/hex.13230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background Evaluations of health interventions for Indigenous peoples rarely report outcomes that reflect participant and community perspectives of their experiences. Inclusion of such data may provide a fuller picture of the impact of health programmes and improve the usefulness of evaluation assessments. Aim To describe stakeholder perspectives and experiences of the implementation and impact of Indigenous health programmes. Methods We conducted a systematic review of qualitative studies evaluating complex health interventions designed for Indigenous communities in high‐income countries. We searched 6 electronic databases (through to January 2020): MEDLINE, PreMEDLINE, Embase, PsycINFO, EconLit and CINAHL and hand‐searched reference lists of relevant articles. Results From 28 studies involving 677 stakeholders (mostly clinical staff and participants), six main themes were identified: enabling engagement, regaining control of health, improving social health and belonging, preserving community and culture, cultivating hope for a better life, and threats to long‐term programme viability. Conclusion The prominence of social, emotional and spiritual well‐being as important aspects of the health journey for participants in this review highlights the need to reframe evaluations of health programmes implemented in Indigenous communities away from assessments that focus on commonly used biomedical measures. Evaluators, in consultation with the community, should consistently assess the capacity of health professionals to meet community needs and expectations throughout the life of the programme. Evaluations that include qualitative data on participant and community‐level outcomes can improve decision‐makers' understanding of the impact that health programmes have on communities. Patient or public contribution This paper is a review of evaluation studies and did not involve patients or the public.
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Affiliation(s)
- Shingisai Chando
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Michelle Dickson
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Jack DeLacy
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | | | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
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Eggleton K, Stewart L, Kask A. Ngātiwai Whakapakari Tinana: strengthening bodies through a Kaupapa Māori fitness and exercise programme. J Prim Health Care 2019; 10:25-30. [PMID: 30068448 DOI: 10.1071/hc17068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Activity based weight loss programmes may result in modest reductions in weight. Despite the small successes demonstrated by these interventions, there are few examples that specifically address the disparity of obesity for Māori compared to non-Māori. AIM This research highlights the results of a Kaupapa Māori fitness and exercise programme that aimed to assist mainly Māori adults, to lose weight. The programme was designed to support participants by using Māori cultural values. METHODS A Muay Thai kickboxing exercise programme was developed with community involvement. Kaupapa Māori principles underpinned the programme, such as whanaungatanga and tino rangatiratanga. Ninety-three participants were followed for at least 3 months. Participants' blood pressure, weight, body mass index, mental wellbeing scores, and waist and hip circumferences were collected at regular intervals. Multiple linear models were used to calculate estimated changes per 100 days of the programme. RESULTS The mean duration of participation was 214 days. The estimated weight loss per participant per 100 days was 5.2 kg. Statistically significant improvements were noted in blood pressure, waist and hip circumference, systolic blood pressure and mental wellbeing. DISCUSSION The improvements in physical and mental wellbeing are thought to have stemmed, in part, from the use of Kaupapa Māori principles. The success of this programme strengthens the argument that programmes aiming to address the precursors of chronic disease need to be designed for Māori by Māori in order to reduce health inequities.
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Affiliation(s)
- Kyle Eggleton
- University of Auckland, General Practice and Primary Health Care, Auckland, New Zealand
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Fazelipour M, Cunningham F. Barriers and facilitators to the implementation of brief interventions targeting smoking, nutrition, and physical activity for indigenous populations: a narrative review. Int J Equity Health 2019; 18:169. [PMID: 31690340 PMCID: PMC6833184 DOI: 10.1186/s12939-019-1059-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/23/2019] [Indexed: 01/02/2023] Open
Abstract
Objective This narrative review aimed to identify and categorize the barriers and facilitators to the provision of brief intervention and behavioral change programs that target several risk behaviors among the Indigenous populations of Australia, Canada, and New Zealand. Methods A systematic database search was conducted of six databases including PubMeD, Embase, CINAHL, HealthStar, PsycINFO, and Web of Science. Thematic analysis was utilized to analyze qualitative data extracted from the included studies, and a narrative approach was employed to synthesize the common themes that emerged. The quality of studies was assessed in accordance with the Joanna Briggs Institute’s guidelines and using the software SUMARI – The System for the Unified Management, Assessment and Review of Information. Results Nine studies were included. The studies were classified at three intervention levels: (1) individual-based brief interventions, (2) family-based interventions, and (3) community-based-interventions. Across the studies, selection of the intervention level was associated with Indigenous priorities and preferences, and approaches with Indigenous collaboration were supported. Barriers and facilitators were grouped under four major categories representing the common themes: (1) characteristics of design, development, and delivery, (2) patient/provider relationship, (3) environmental factors, and (4) organizational capacity and workplace-related factors. Several sub-themes also emerged under the above-mentioned categories including level of intervention, Indigenous leadership and participation, cultural appropriateness, social and economic barriers, and design elements. Conclusion To improve the effectiveness of multiple health behavior change interventions among Indigenous populations, collaborative approaches that target different intervention levels are beneficial. Further research to bridge the knowledge gap in this topic will help to improve the quality of preventive health strategies to achieve better outcomes at all levels, and will improve intervention implementation from development and delivery fidelity, to acceptability and sustainability.
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Affiliation(s)
- Mojan Fazelipour
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Frances Cunningham
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Level 10, 410 Ann Street, Brisbane, QLD, 4000, Australia
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