Being Heard, Being Valued, Being Understood-Aboriginal Community Perspectives on Adapting a Healthy Lifestyle Program for Boorloo/Perth, Western Australia: A Qualitative Study.

内容摘要

Childhood obesity prevalence is increasing globally, with Aboriginal and Torres Strait Islander children over-represented in Australian data. Evidence-based, community healthy lifestyle programs require culturally safe adaptation when implemented in new First Nations contexts, where prioritising access and engagement of First Nations groups is critical. This study aimed to identify Aboriginal community representatives' perspectives on potential barriers and enablers to recipient engagement and program implementation, and to identify cultural and place-based considerations to inform culturally safe adaptation of Whānau Pakari from Aotearoa/New Zealand for delivery as the Healthy Lifestyle Program in Boorloo/Perth, Western Australia. A 3-h workshop was conducted with 29 Aboriginal advisors, with whole-group discussions and 5 facilitated breakout groups, to obtain Aboriginal community guidance on cultural and place-based considerations needed to adapt the program locally. Data were analysed by Framework Analysis using the updated Consolidated Framework for Implementation Research (CFIR) to identify barriers and enablers (determinants) of program engagement and implementation. Determinants were then reclassified inductively into themes to enhance participant relatability, supporting communication and feedback. A total of 44 potential determinants (16 barriers and 28 enablers) were mapped to 18 CFIR constructs across all five domains of innovation, outer setting, inner setting, individuals and implementation process. Three themes were identified from these determinants: acknowledging cultural context encompassed healing and self-determination, reclaiming knowledge and culture, and addressing limited access to health-promoting environments; guiding values included mutual respect, building and earning trust, and intergenerational learning; and program considerations included culturally secure practice, specific ways of working, and keeping families engaged. Aboriginal community guidance highlighted cultural and place-based priorities for program adaptation, and potential determinants of successful implementation within a prevailing healthcare service, iteratively informing program adaptation. This study used a unique methodological approach, prioritising participant voice alongside CFIR terminology, to provide rare evidence of pre-implementation First Nations engagement outcomes when adapting a program to integrate into the prevailing healthcare service. Partnership with First Nations communities is essential to implementing accessible, culturally safe models of care, thereby addressing health inequities. An established Cultural Advisory Group of 12 Aboriginal Elders worked in partnership with the Healthy Lifestyle Program, 10 of whom reviewed the identified themes and sub-themes throughout the analysis process. Two members were nominated by the group and reviewed the final draft manuscript. Identified determinants iteratively informed program adaptation, guided by the Cultural Advisory Group. This work was also supported and guided by a representative consumer body, Health Consumers' Council WA.