Program areas and participant contacts
There was a wide range of activities addressing a number of environmental and social determinants of health, as well as physical activity. The programs assessed for this evaluation were, at Viney Morgan AMS:
Sister Girl program, which provided a safe and cultural space for community members to participate in activities that encouraged lifestyle changes in order to improve health and well-being, throughout the program and more widely. Over a period of 10 weeks the women would participate in activities in the gym, discuss healthy eating, sharing stories and, most importantly, support each other. The program thus promoted social and cultural connectedness between women, participants’ health knowledge and behaviour, and increased access to services (in this case, a gym) through organisational networking.
Ladies’ Art and Craft program sessions gave women the opportunity to come together and experience new ideas through their talents in jewellery making, sewing and other craft activities. Older women shared their knowledge with younger women, encouraging and supporting each other. The setting and the activities themselves were an important factor in bringing women out of their homes and into a safe place. It also provided women the space and time to talk about issues of health, family, budgeting, cooking—there were no boundaries attached. Hence social and cultural connectedness was a major aim of this program also, supported by the creation of a safe environment in which knowledge was shared.
At RFNC: Makin’ A Move, a fitness and weight loss program initiated by RFNC for community members. The 10-week program had two fully trained Fitness Instructors as co-ordinators (one from University of Melbourne, one from RFNC). Community and family members took part in walking laps around the oval and joining in group exercise classes at a local mainstream gym, and participated in discussions about ways to achieve better nutrition. The program also incorporated elements of the ‘My Moola’ financial literacy program. In addition to increasing participants’ knowledge of nutrition and supporting physical activity (including through networking between organisations), the program strengthened social and cultural connections through group activities.
The Fruit Share program provided fruit at RFNC on training nights so that Club members and players could choose healthy snacks before training. The activities particularly targeted junior players arriving at the ground after school so they had enough energy to train effectively. In this way the RFNC environment was modified to support healthy eating among club members.
The annual Unity Cup football and netball matches between RFNC and Congupna FNC aimed to promote social inclusion through reaffirming, celebrating and taking pride in First Peoples among all the communities of the region, showcasing the value of community to government at all levels, honouring all women and Elders and supporting young peoples’ role in community. Although an annual event, the Unity Cup leads to sustained change through the creation of new social norms of behaviour. The theme, ‘Honouring the Role of Women in our Communities’, was reflected in a very special spiritual performance, that allowed all women and children present on the day to walk side by side across the oval as local Elders carried burning gum leaves that represented the connection to country. As well as football and netball matches, activities held as part of the event included the sporting teams’ President’s lunch, with guest speakers from community and local and state governments. The activities of Unity Cup thereby sought to strengthen a very broad range of influences on First Peoples’ wellbeing—relationships with other community members, cross-cultural relationships with members of other local communities through promoting recognition of First Peoples’ culture within the football/netball league, and attitudes in the broader society through engagement with government.
The RFNC Mural was developed for display in the social rooms of the club in collaboration with the Yarrwul Nyuwandan Social Inclusion Project. The wall is a visually inspiring cultural statement of ‘Survival and Strength!’ It weaves together just a glimpse of the many representations that strongly connect us to our Dreaming. The wall honours First Peoples’ ways of knowing, seeing and doing, and it acknowledges and values our right to keep our spirituality on going since time began. This program promoted cultural maintenance and development within community through enhancing the environment at RFNC.
The
Three Healthy Messages project, a collaboration with RAC, engaged several youth of the RFNC community to propose ways of promoting healthy living ideas to other youth. In a series of workshops they talked about different issues relevant to them as young people and also the effect of those on their family and community. The group identified three issues in health—binge drinking, smoking (tobacco use), and other drug use (particularly cannabis). The young participants brainstormed ideas and generated messages that were then communicated to other young people in the form of a short film clip as the end result of the whole program [
27]. They also produced some promotional material, including posters and t-shirt designs. The participants were introduced to script writing and multimedia techniques to produce the film clip. The project developed the capacity and skills of the individual participants and the organisations involved, their social and cultural connections, and sought to influence community and society through posting the film clip on the world wide web.
At RAC:
Lulla’s Health Check Day, a Children’s health check day conducted by RAC Health Promotion Unit. Parents were invited to attend with their 3 and 4 year old children. The checks were completed in 5 steps and included general measurements like height and weight, Parents’ Evaluation of Developmental Status [
28], hearing checks, and eye testing. The health checks aimed to strengthen children, families and community.
The Divine Breast Day activity invited women from the community to join together to enjoy a day of pampering, yarning and education on breast health. The room was decorated in pink, purple and silver with lots of donated bras hanging everywhere. Women were encouraged to dress in pink and to bring an old bra with them. Prizes were given out for the best-dressed and the oldest bra and the judging was done by women. This broke the ice and women became comfortable to yarn and tell their stories and share history of their journey related to breast cancer. This was a very powerful and moving experience for all the women. Lunch was provided which gave the women more time to connect with each other and to ask further questions of the professionals present. Bookings were taken for breast screening on the day and followed up with reminder calls, transport and follow ups. The activities aimed to improve health for women through providing them with information both directly and through connecting with other women, and by increasing service accessibility through networking between organisations.
The Koori Maternity Services (KMS) team ran a cooking program called Winyarr (meaning “Aboriginal Women”) in which women came together and cooked healthy foods, shared ideas and connected over a meal. KMS also ran a belly-casting event for mothers and babies. This activity provided the mum-to-be with a special connection to the new baby. These activities thus aimed to strengthen families through working with mothers.
The Elders’ Exercise Group provided Elders, all of whom live in full time care, a fun and interesting way to interact with each other, help maintain their movement and strength, and provided a space for Elders to interact on a social and emotional level through conversation, stories and lots of laughter. The coordinator developed activities with the use of light hand weights, different size balls, stretching and balance. As well as promoting participants’ physical fitness, these activities were important for promoting social connections and for passing on cultural stories within the community.
Table
1 shows the number of activities analysed per program and the demographic characteristics of each program’s target groups. Across the programs making up the Health Promotion Alliance activities, all ages were represented, as were Elder and family groups. While several programs were specifically designed for women, and others for youth or infants, none were specifically for males (although a number did include male participants, and the Unity Cup football match is played by men).
Table 1
Programs and estimated participant contacts
Sister Girl | VMAMS | 19 | 0 | 0 | 0 | 72 | 72 | Y | Y |
Ladies’ Art & Craft | VMAMS | 8 | 1 | 0 | 4 | 34 | 39 | Y | Y |
Makin’ a Move | RFNC | 31 | 0 | 0 | 22 | 97 | 119 | N | N |
My Moola | RFNC | 3 | 0 | 0 | 1 | 8 | 9 | Y | N |
Fruit Share | RFNC | 2 | 1 | 20 | 40 | 0 | 60 | N | N |
History Wall development | RFNC | 2 | 2 | 1 | 0 | 19 | 22 | Y | N |
Unity Cup | RFNC | 6 | | | | | 400 + a | Y | Y |
Lulla’s Health Check | RAC | 1 | 35 | 0 | 0 | 0 | 35 | N | Y |
Divine Breast Screen | RAC | 1 | 0 | 0 | 7 | 49 | 56 | N | N |
Koori Maternity Services | RAC | 2 | 0 | 0 | 0 | 3 | 3 | N | N |
Elders’ Exercise Group | RAC | 8 | 0 | 0 | 0 | 38 | 38 | Y | N |
3 Healthy Messages | RFNC/RAC | 5 | 0 | 0 | 19 | 0 | 0 | N | N |
Ecological analysis
Table
2 shows the various strategies used across the 12 programs, coded using the modified ecological coding procedure as described in Methods. A variety of strategies were used to address the program aims, most of which were based on strengthening relationships between people, and sometimes between organisations within First Peoples’ community and in the broader society. Using this method we found that strategies used in these health promotion programs could be categorised into five themes based on their ultimate target. These were:
Table 2
Frequencies of intervention strategies for 88 activities across 12 programs
HP → [IND-IND] → INT → COM | 9 | Bringing Elders together in the Elders Exercise Group to exercise, share stories for maintaining culture in community |
HP → IND → INT → ORG → COM | 2 | Weaving raffia for RFNC Mural, maintaining culture, developing RFNC environment, for community development |
HP → IND → INT → COM | 1 | Lulla’s Health Check Day to assess children, build capacity of carers, leading to stronger Aboriginal community |
HP → INT-ORG-COM | 1 | Aboriginal youth develop Three Healthy Messages film clip for community |
HP → [IND-IND] → INT | 53 | Bringing women together to strengthen social connections in Sista Girl |
HP → IND → INT | 10 | Learning to shop on a budget for the family in Makin a Move |
HP → INT | 4 | Sharing knowledge in group via social networks at the Devine Breast Day. |
HP → [COM-COM] → INT | 1 | Women from 2 communities meet to strengthen social connections in Ladies Art and Craft |
HP → [ORG-ORGm] → INT | 1 | Presentation of the Unity Cup, bringing together RFNC and CFNC to strengthen social relationships |
HP → [ORG-ORGm] → ORGm → INT | 1 | Bringing together RFNC and CFNC for the Unity Cup, to promote cultural competence in the Murray Football League |
HP → IND | 71 | Increasing knowledge of health, nutrition, financial literacy in Makin a Move |
HP → [ORG-ORGm] → INT → IND* | 21 | Koori orgs and mainstream gyms work together to create a culturally safe environment for physical activity in Sista Girl |
HP → INT → IND | 4 | Strengthening relationships between younger and older women to promote breast health at the Devine Breast Day |
HP → [INT-INT] → IND | 1 | Unity cup football match, promoting wellbeing among men |
HP → ORG | 8 | Creating a culturally safe space for community women in Sista Girl |
HP → [IND-IND] → INT → ORG | 4 | Training young people to produce Three Healthy Messages film clip |
HP → IND → INT → ORG | 2 | Fruit Share provided for RFNC junior players to strengthen team and club |
HP → [IND-IND] → ORG | 1 | Participants provide input on program design in Three Healthy Messages |
HP → COM, SOC | 1 | Aboriginal-produced Three Healthy Messages film clip uploaded to the internet |
HP → INT → COM, SOC | 1 | Guard of honour for women at Unity Cup, strengthening Aboriginal and mainstream culture |
HP → [INT-INT] → COM, SOC | 1 | Senior football teams play for Unity Cup to strengthen community and mainstream society |
HP → [IND-IND] → INT → SOC | 1 | Aboriginal and mainstream community members come together at Unity Cup to promote recognition of First Peoples |
Cultural maintenance and community development,
1 in which the First Peoples’ community [COM] is the ultimate intended beneficiary of the activities. For example: activities at RFNC such as the History Wall were specifically about strengthening collective cultural identity via working with groups of participants [IND, INT] to develop the organisational environment [ORG], and RAC Elders’ group [IND-IND] exercise program included elements of sharing stories and connections [INT] for cultural maintenance;
Social and cultural connectedness, which involved (re)connecting to strengthen culture, spirit, family and identity as a priority outcome. These fall within the interpersonal [INT] domain in our revised scheme (Fig.
1, Table
2) and commonly occurred through implementing group exercise or art activities [IND-IND] for example, or through targeting families by building capacity of mothers [IND]. Activities targeting First Peoples’ relationship with organisations other than ACCOs and staff members were also present by increasing cultural safety at gyms and within the sporting competitions through organisational networking [ORG-ORGm];
Individual knowledge and behaviour such as providing information about diet and financial literacy at the individual [IND] level. This rarely if ever occurred in isolation from strategies that also aimed to strengthen social and cultural connections [INT];
Developing organisations and programs [ORG] to make them culturally safe, healthy and accessible for community members. For example, developing programs such as 3 Healthy Messages and Makin’ A Move involved bringing participants together [IND-IND] to both strengthen relationships [INT] and to optimise program design;
Building cross-cultural relationships between the wider society [SOC] and First Peoples. Influencing societal attitudes to First Peoples is considered an important way to reduce health inequities, and the Unity Cup was one initiative that sought to achieve this through engagement with diverse community members, organisations and governments.
Thus, in terms of the ultimate intended target of program strategies, for 49 % of observed strategies, individual program participants were targeted, either directly by exercise and educational strategies or through personal networks and organisational partnerships. Strategies bringing individuals, communities or organisations together for strengthening relationships were also frequent (35 % of all activities)—most activities were group-based and creating and strengthening relationships between participants was an aim of these types of programs, while some activities aimed to give participants knowledge about healthy eating and recipes to take back to family. The majority of strategies included some form of social connectedness as part of their design. A substantial minority (7 %) of strategies were ultimately and explicitly about strengthening community into the future. A similar proportion sought to promote cultural safety within organisations (including organisations other than ACCOs) and several were aimed at changing societal attitudes.
Overall, four different types of proximal (initial) targets were identified, the majority of them (78 %) at the individual level. Sixteen percent of strategies directly targeted organisations or organisational relationships. For example, RFNC was identified as an organisational target through its partnership with other institutions (e.g. University of Melbourne) to develop and run programs like ‘Makin’ A Move’, and through providing a healthy eating environment through the ‘Fruit Share’ program. One activity as part of Ladies’ Art and Craft program aimed to strengthen the connection between two communities.
The programs assessed in this review recruited participating people and organisations from four types of settings: from the community (e.g. Cummeragunja residents participating in
Ladies’ Art and Craft); from within the participating organisations (e.g. RAC clients in
Koori Maternity Services); from within organisations (e.g. from a regional football league as part of
Unity Cup); and from the broader society (e.g. by engaging local and state government organisations). Just under half of the programs recruited from a single setting, and this was most often the organisation (Table
3). Fifty percent of programs recruited from two or three settings. One program,
Unity Cup at RFNC, recruited participants from four different settings, including multiple ACCOs and other organisations and the broader society. RFNC engages with mainstream organisations and society routinely through its involvement in sport and other activities and hence often recruits program participants from a range of settings. VMAMS, which is relatively isolated geographically, also engaged frequently with other settings including access to gyms. RAC most often recruited from within its own organisation, as it is located in a population centre and services a large client base.
Table 3
Frequency of programs (n = 12) according to number and types of intervention setting
One | 5 | community (1); organisation (4) |
Two | 4 | organisation, mainstream organisation (1); community, organisation (4) |
Three | 2 | community, organisation, society |
Four | 1 | community, organisation, mainstream organisation, society |
Collectively, this represents a very good design for a program of health promotion, with multiple settings, a range of individual and environmental target types, and numerous and innovative strategies.