Background
Methods
Program development theory
Strategies | Our approach |
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1. Defining research questions: Cultural knowledge
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• Does the question reflect an authentic awareness of the culture? | • Our previous work in this population and pilot studies have established evidence on the current health problems prevalent in this population |
• Has previous research related to the population been critically acknowledged? | • Follow up studies will be conducted to establish the extent of the problem |
• How does the question relate to current health care problems? | • African Review Panel ensured that the methodology is culturally appropriate |
• Is there an indication of knowledge of appropriate ways of developing and maintaining trust? | |
• Is the guiding methodology consistent with culture? | |
2. Cultural sensitivity
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• What mechanisms are used to enhance cultural appropriateness? | • A cultural competence framework and community-partnered participatory approach was applied |
• Do the participants define the health issue as a priority problem? | • African Review Panel and African bilingual workers were integral in advising about cultural appropriateness |
• Is there evidence of a flexible process throughout data collection? | • Our previous research indicated this to be a priority problem for this sub-population |
3. Collaboration
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• Was the problem developed with the target population? | • Community consultation and collaboration occurred throughout the process – from the pilot studies to the development of the final HMFI program (refer to main text) |
• At what level were the participants involved? | • The level of participation varied depending on the phase of the project – for instance, the ANGELO workshop was community driven, the pilot interviews were conducted by community members, and the community were consulted at numerous stages of the HMFI program development |
• Were participants involved in the development and implementation of methodology? | |
4. Forming partnerships
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• Did the researchers work through gatekeepers to establish peer educators (community workers who are of the same cultural background as participants matched to the culture, language, gender, age and life stage of the research participants)? | • Formation of partnerships with community gatekeepers was essential in collecting pilot data – often the person collecting the data was required to seek permission from the President (gatekeeper) of the community before commencing work within the community group. The same will be vital in implementing the program. |
5. Identifying data sources and target populations
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• Do the researchers recognize their own cultural framework and its influence on the research approach? | • African review Panel and African bilingual workers ensured that a culturally congruent approach was maintained |
6. Appointing staff
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• Did the researchers ensure involvement of peers, not just community gatekeepers? | • The African Review Panel and African bilingual workers are both composed of a range of people – some are community gatekeepers, some are community-nominated, and some are involved for other reasons e.g. they have work experience or a personal interest |
7. Recruitment of sample
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• Do the researchers recognize diversity within cultural groups? | • The African Review Panel and African bilingual workers are key in assisting the researchers in understanding the cultural diversities within the African communities |
• Recognize potential power imbalances in working and consultation? | • To minimize power-balance effects, participant recruitment utilized a strategy where communities elected one of their own for training in recruiting families to the study and conducting the interviews. |
• Recognize differences in defining language and cultural identity? | |
8. Data collection
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• Is the methodology responsive to cultural and migration considerations (e.g. family groups rather than individual interviews, use of professional interpreters rather than family members) | • The methodology was culturally appropriate due to input from the African Review Panel |
• Were data collected by local community organizations or community members? | • Data for the pilot studies were collected by community elected members who received training in data collection methods (e.g. interview techniques, ethical considerations) |
9. Analysis/evaluation
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• Were peer educators involved in the analysis and interpretation of the data? | • Two community forums were held to present and discuss the results of the pilot studies and discuss the plans for the program |
• Was there feedback from the participants to confirm the results? | • Feedback was also sought from the African Review Panel into the content of the program |
10. Reporting/disseminating findings
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• Was there an opportunity for the community to discuss findings and generate solutions? | • In addition to the community forums and African Review Panel meetings (see box above), the ANGELO process (on which one of the pilot studies was based) [25] allowed the community to generate their own solutions, which fed back into the HMFI program plan |
Community participatory approach
Target population and the program development process
Results
Program overview
Session number | Module | Session title | Purpose | Key messages | Activities |
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1 | Healthy families in a new culture | Living in Australia and how it affects your health | To identify and discuss the differences between living in Australia and living in Africa | • Life in Africa and life in Australia are different in many ways (culture, lifestyle, food, transport, school, support, etc.), which all impact on the health | Group discussion and activities to introduce the parents to each other and some of the basic concepts to be covered during the program: |
• Introductions/icebreakers | |||||
• Defining health (ecological definition) | |||||
• Devising strategies for living a healthy life | |||||
• The differences between living in Africa and Australia | |||||
2 | Healthy families in a new culture | Raising teenagers in a new culture | To encourage positive family relationships and discuss the challenges families may face when moving to Australia and ways in which these challenges can be overcome | • Parenting is challenging for everyone, regardless of where they come from | Group discussion and activities to show parents that they are not alone in the challenges that they face raising their teenagers, and as a way of sharing strategies for overcoming such challenges: |
• Changes/challenges faced in moving to a new country | |||||
• Devising strategies for bridging the cultural gap between parents and teenagers to build more positive relationships. | |||||
• Strategies to assist parents to be positive role models and reduce the cultural gap with their children | |||||
• Take home activity: discuss and implement the strategies for building positive families with their family they learned during the session, and make a plan to implement some of the strategies at home | |||||
3 | Healthy lifestyles in a new culture | Body shape and active living | To promote physical activity as part of a healthy lifestyle and devise strategies to encourage regular physical activity | • Cultural differences regarding healthy body shape/size preferences | Group discussion and activities to examine various contributors to body shape and brainstorm strategies for increasing activity levels: |
• Selecting ‘healthy’ body shapes from the Australian and African perspective using silhouettes of various body shapes | |||||
• Contributors to various body shapes/sizes | |||||
• Differences in lifestyle between Africa and Australia | |||||
• The benefits of physical activity for body weight, health, lifestyle, and families | |||||
• Types of sedentary activities, and strategies for increasing activity in the family | |||||
• Take home activity: take note of the amount of electronic media the family uses in their leisure time and compare these to the recommended guidelines; and talk with their family about implementing strategies that will increase the health and activity levels of the family | |||||
• Physical activity recommended guidelines | |||||
4 | Healthy lifestyles in a new culture | Understanding healthy eating | To promote the benefits of healthy eating and introduce the healthy food pyramid | • Basic principles of healthy eating using the ‘healthy food pyramid’ (adapted to include traditional African foods) as a guide, with a focus on individual foods/food groups and how often to consume those foods as part of a healthy and balanced diet | • Group discussion and activities to develop and consolidate understanding of the basic principles of healthy eating: |
• Discussion of the benefits of healthy eating | |||||
• Estimating the number of teaspoons of sugar in glasses of common drinks | |||||
• Sorting picture cards of foods into ‘eat most’, ‘eat moderately’, and ‘eat least’ (in accordance with the healthy food pyramid) | |||||
• Take home activity: bring a copy of a favourite recipe that they cook frequently for a family meal. Put their (magnetic laminated) copy of the healthy food pyramid on their fridge or wall at home | |||||
5 | Healthy families in a new culture | Improving family communication | To equip parents with tools (active listening, assertiveness, and “I” messages) for better communication with their family | • Cultural differences in family communication, and strategies for improving communication within the family | Group discussion and activities about strategies for good communication: |
• Discussion of challenges in communication with teenagers and brainstorming strategies for resolution of them | |||||
• Activities to practice using active listening, assertiveness, and “I” messages using example scenarios which might be common African migrant families | |||||
• Take home activity: practice the active listening and “I” message skills at home with their family | |||||
6 | Healthy families in a new culture | Raising a family in Australia: discipline and conflict resolution | To equip parents with strategies to resolve conflict within their family and discuss cultural difference in discipline methods between Africa and Australia | • Different styles of parenting exist | Discussion and activities about resolving conflicts within the family: |
• Often Australian and African parents resolve family conflict | • Discussion of the similarities and differences in raising a family in Africa and Australia, | ||||
• and discipline their children in different ways | |||||
• Brainstorming alternative solutions to discipline than corporal punishment | |||||
• Australia has different laws compared to most African countries regarding discipline of children | |||||
• Steps for conflict resolution | |||||
• Take home activity: practice the conflict resolution steps/alternate discipline strategies at home in family issues that arise | |||||
• Alternative ways of disciplining children that are also helpful for building positive family relationships | |||||
7 | Healthy lifestyles in a new culture | Making healthy choices at home and away from home | To encourage parents to apply the principles of healthy eating principles when cooking meals at home and purchasing food outside of the home | • How to incorporate the principles of healthy eating when preparing meals at home and selecting foods away from home | Discussion and activities to develop skills in making healthier food choices for the family: |
• Modification of recipes to make them healthier | |||||
• Sorting laminated A4 picture cards of various meals into ‘most healthy choice’, moderately healthy choice’ and ‘least healthy choice’ | |||||
• How to prevent food contamination and food poisoning (food safety) | |||||
• Food safety | |||||
• Take home activity: test one of the modified recipes at home | |||||
8 | Healthy lifestyles in a new culture | Healthy breakfasts, lunches and snacks | To encourage parents to plan meals and inspire appropriate, healthy meals for the whole family | • Small regular meals (e.g. 5–6 small meals per day) are recommended for good health | Discussion and activities to build skills in preparing healthy meals: |
• Discussion of the importance of breakfast | |||||
• Brainstorming ideas to encourage breakfast and school lunch consumption | |||||
• Discussion of ideas for healthy breakfast and lunches | |||||
• Sorting laminated A4 picture cards of snacks into ‘healthy’ and ‘unhealthy’ | |||||
• Appropriate healthy foods for breakfast, lunches and snacks | |||||
• Developing a healthy meal plan (whole day) for their teenager using A4 laminated picture cards | |||||
• Strategies for encouraging teenagers to eat their lunch at school | |||||
• Take home activity: discuss the session with their family and incorporate lessons learnt. And collect their grocery shopping receipts for 1 week to bring to session 9 | |||||
9 | Healthy lifestyles in a new culture | Smart shopping | To apply the principles of healthy to grocery shopping and discuss strategies for ‘smart shopping’ including budgeting, and reading food labels | • How to read food nutrition labels | Discussion and activities to build skills in shopping for healthy foods: |
• Analyse the healthfulness of their families food consumption using their grocery receipts and a colour code system | |||||
• Practice reading food labels using A4 laminated picture cards and a laminated wallet-sized shopping tool | |||||
• Pre-planning can help to make cost-effective and healthy food purchases | |||||
• Brainstorm ways to save money on food | |||||
• Take home activity: devise solutions for making healthy changes to their grocery shopping with their family, plan their weekly family meals and prepare a shopping list, and practice reading nutrition labels using the shopping tool | |||||
• Healthy eating is affordable and most of the time, healthy food is cheaper than unhealthy food | |||||
• Certificates handed out to participants who complete the program |
Program implementation
For participants and facilitators
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Picture cards of food, ingredients and relevant nutritional information – cards to facilitate discussion about the healthfulness of different foods and meals
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Session summaries – summary sheet of each session for the participants to take home and share with their families
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Other educational aids – healthy food pyramids adapted to include common traditional African foods for each participant to keep at home, and wallet-sized laminated food choice decision aids for use at the supermarket