Caroline Nilson Sharree Kearing Murdoch University Murray Districts Aboriginal Association

The Bindjareb Yorgas Health Program: Improving the

health of women and their families

• This PowerPoint template has been designed using an art piece painted by Mrs Gloria Kearing, a well respected Bindjareb Nyungar woman Elder of the Murray District Aboriginal Association from Pinjarra.

• The art piece depicts the 3 main camps in the Bindjareb region that she remembers her family travelling between when she was a child.

• I am humbled and honoured to have been presented with the painting, which was described by Mrs Kearing as a symbol of her mob’s acceptance of me.

Acknowledgement

• This intervention research is aimed at “closing the gap in indigenous health outcomes” (DIACOAG, 2010).

• The health gap between Indigenous and non-Indigenous (ABS, 2010)

• Indigenous males - 67.2 years compared with non-Indigenous males at 78.7 years

• Indigenous females - 72.9 years compared with non-Indigenous females at 82.6 years

Introduction

• The Bindjareb Yorgas Health Program (BYHP) aims to address the high prevalence of health issues experienced by Aboriginal women and their families (Thomson et al., 2010) in the town of Pinjarra, Western Australia, through the establishment of a holistic community owned and developed health and wellness program.

Introduction

• The intervention will focus specifically on three action areas for undertaking health promotion:

1. creating supportive environments to encourage equitable access;

2. strengthening community actions to enable empowerment; and

3. development of personal skills in achieving and maintaining wellness.

Focus

• The intervention has been developed using a multi-faceted approach to promoting healthy eating and improved fitness within the context of Nyungar lore. It comprises four components:

1. group fitness and exercise sessions; 2. nutrition education and cooking classes; 3. Nyungar lore, communicated through Kaartdijin

yarning sessions; and 4. vegetable growing

Multi-faceted approach

This combination was agreed upon as it specifically addresses the Bindjareb

women’s concerns regarding the need for a more culturally appropriate approach to

health promotion to address health issues being experienced in their community.

Women of the Murray District Aboriginal Associsation (MDAA)

Cooking with the "Deadly Koolinga Chefs" (DKC)

The "Deadly Koolinga Chefs" program was conducted in 2011 as a seed project. A group of eight children

aged 11 & 12 years participated in a 12 week nutrition and cooking

program.

This program will continue in 2012 - Funding supported by Community

Development Foundation (CDF)

Community Vegetable Garden Program

The aim of the community vegetable garden program is to provide produce

for the continuation of the cooking programs and for use by the local

community.

A small scale garden will be developed on the grounds of the MOASH building

in 2013 for the BYHP and DKC programs

The community vegetable garden project will fully established when the

refurbishment of the Bindjareb Community Centre, Pinjarra is complete

.

Bindjareb Yorgas Health Program (BYHP)

A health promotion program for the women, aimed at developing health

literacy, health awareness and skills to engage in healthy life style choices.

Proposed for development in and commencement in 2013.

Teen Program

(proposed)

The Teen program will be aimed at providing health education and

health promotion on sexual health, reducing harm from tobacco, drugs

and alcohol, good nutrition, goal setting and maintaining good

mental health.

Proposed for development in 2013 and implementation in 2014

The Holistic Program

Group fitness

sessions

The sessions will be conducted 3 times per week. The objectives will be to reduce

sedentary behaviour; improve cardiovascular fitness and promote wellbeing. The sessions

will be conducted as a group activity. The main aim of group fitness is to encourage

inclusion, participation and camaraderie.

Nutrition

education

and cooking

classes

This session will be conducted once a fortnight week. The learning outcomes will be to

gain a greater understanding about healthy nutrition and the importance of eating well to

promote and maintain health and wellbeing. The objectives will be for the women to

participate in:

supermarket tours to gain knowledge of foods nutritional value;

cooking sessions using healthy recipes for family meals as well as school lunches;

information sessions on how to eat well on a budget.

Nyungar

lore;

Kaartdijin

yarning

sessions

These sessions will run alternately to the cooking classes and the topics will be determined

by the women. Nyungar lore is the body of knowledge or kaartdijin in oral tradition and

observed in the customs, rituals and behaviours of Nyungar people. During these sessions

Nyungar Elders will share a set of lore and customs relating to marriage, food, all aspects

of womanhood, land ownership and access. Guest speakers and professional will also

contribute to information sharing. Kaartdijin belongs to Nyungar people only and is

therefore essential to maintaining health and wellbeing.

• Kelly-Anne Mordjt - Bachelor of Anthropology; Certificate III in Fitness (SRF30206), Certificate IV in Fitness (SRF40206)

• Caroline Nilson - RN, Midwife, Sports Medicine Awareness Certificate

• Karrie-Ann Kearing-Salmon - Bindjareb Leader and Research Associate

Fitness

• Keith Savage (Torres Strait Islander Elder)- Cooking Class Instructor

• Caroline Nilson - RN, Midwife - Food Safety Supervisor (Cert), Food Safety Handler (Cert).

• Karrie-Ann Kearing-Salmon - Bindjareb Leader and Research Associate

Nutrition and Cooking

• Mrs Gloria Kearing - Bindjareb Elder

• Ms Lesley Pickett - Bindjareb Elder

• Karrie-Ann Kearing-Salmon - Bindjareb Leader and Research Associate

• Anna Moore - RN, Child Health Nurse

• Caroline Nilson - RN, Midwife - Certified Child Birth Educator

• Sharree Kearing - Bindjareb Leader

Kaartdijin Yarning Sessions

• The BYHP is being developed at the request of the Bindjareb women from the Murray District Aboriginal Association (MDAA) in Pinjarra, following the success of a 2011 seed project; “The Deadly Koolinga Chefs” (DKC).

• The DKC program engaged a group of 12 year old Bindjareb children in a 12 week nutrition and cooking adventure, where they learned how to plan, shop for and prepare a healthy meal for four.

Background Each week the children took home their prepared meals, together with their new skills and knowledge, to share with their

family. This resulted in a request by the Bindjareb

women for a broader health promotion program to address the health and

wellbeing of the community’s women and by association, their families

• facilitating community ownership and leadership of an Aboriginal health promotion program;

• provide both short and long-term improvements in the physical activity and healthy eating habits;

• serve as a template for similar health promotion programs in other communities;

• develop empirical evidence to contribute to “closing the gap” in Indigenous health outcomes (DIACOAG, 2010); and

• identifying environments that encourage Aboriginal participation

Significance

• The development of the BYHP will aim to address the most common risk factors causing deaths in Indigenous people through promoting healthy eating and exercise and the avoidance of risk behaviours such as smoking and alcohol use.

Consequently: • The literature (for this proposal) examined

knowledge gained from recent Health Promotion initiatives in Australian Aboriginal communities

Literature Review

• ‘one program fits all’ not beneficial approach – empowerment & self-determination must be central (Jamieson and Heron, 2009).

• Aboriginal people in urban settings have loose networks of dispersed families; may not be ‘heard’ in local planning and decision-making leading to food insecurity (Browne et al., 2009).

Summary of the Literature

• policy makers to drive the development of physical activity initiatives offered to communities (Booth and Oakley, 2005).

• smoking status of Aboriginal Health Workers a barrier to providing quit support to their communities (Thompson, 2010).

• skills development education leads to self-determination and reduced alcohol abuse (Nichols, 2010).

• strength-based approach to health promotion initiatives - strength audits rather than needs assessment (Brough et al., 2004).

• no published literature on urban community-owned Aboriginal Health Promotion initiatives in Western Australia.

• narrative inquiry connects events, actions and experiences drawing Aboriginal participants and researchers together (Wilson, 2007) .

• “whole life” view must be incorporated to address the holistic sense of Aboriginal "well being” (McLennan & Khavarpour, 2004).

• engagement of Aboriginal stakeholders throughout planning, implementation and evaluation process of Aboriginal research is crucial (Bindon et al., 2009).

Emeritus Professor Rhonda Marriott

RN, Midwife, PhD

Kulbardi Aboriginal Centre - Murdoch University

Project lead, ARC Indigenous Research Triple PMH PCS WRAP project

Honorary Research Fellow and Chief investigator on NHMRC Centre for Research Excellence in Aboriginal

Health and Wellbeing

Ms Sharryn Batt

Diploma Health Science (Nursing) (WACAE); Bachelor of Nursing (ECU); Graduate Diploma Advanced Nursing

(Education)(La Trobe); Master of Health Promotion (Curtin)

Mrs Caroline Nilson

Bachelor of Science (Nursing) (Curtin)

Bachelor of Midwifery (Post Reg) (Flinders)

Masters of Nursing (Research)

PhD Candidate

Mrs Anna Moore

RN, Community Child Health Nurse Pinjarra

Bachelor of Science (Nursing)

Graduate Diploma in Child Health

Aboriginal Registered Nurse/ Aboriginal Health Worker

Ms Karrie -Anne Kearing-Salmon - Bindjareb Leader and Study Research Associate

Certificate IV Tourism; Certificate in Heritage Management; Certificate in Leadership; Certificate in

Train the Trainer

Ms Sharree Kearing - Bindjareb Leader

Certificate in Leadership

Mrs Gloria Kearing - Bindjareb Elder

Ms Lesley Pickett - Bindjareb Elder

Planning & Implemenation,

Review

Stakeholders & Partners

Peel Development Commission

By partnering with industry, community and government agencies, the

Commission initiates and accelerates regional development projects that have a

sustainable benefit to the Peel Region.

The PDC is committed to the redevelopment and reestablishment of the Bindjareb Community Centre. It is

planned that the suite of health education and health promotion programs will run

from the centre to provide continued community involvement and engagement.

Community Development Foundation

The CDF is a not for profit charitable foundation that was founded in 1999 by

Barry Cable and Jenny Day and is overseen by a Board of Directors.

CDF provide the use of the MOASH building to currently run the programs

from and also assist with obtaining funding to purchase cooking equipment

and ingredients and produce for the "Deadly Koolinga Chef "program.

Nutrition Australia ( WA)

Provision of education sessions on nutritional importance to maintain health

and wellbeing

Asthma Foundation

Effective smoking cessation intervention

NAPS project: "care for my air" & "fresh air grows solid babies"

Arthitis Foundation (WA)

Information sessions on recognising early signs of arthritis; management and

maintenance of a healthy active life with arthritis

Western Austaralian School Canteen Association

Workshops and cooking demonstarations for engaging parents and encouraging

healthy eating in their children while at school

National Heart Foundation

Provision of information sessions

on topics such as blood pressure

and cholesterol and management of chronic disease

Diabetes (WA)

"get on track challenge"

"my healthy balance"

self managed physical activity and healthy eating programs

• Investigate the effectiveness of the BYHP on improved health outcomes and health behaviours;

• Investigate the effectiveness of the BYHP on community empowerment and self-determination; and

• Investigate the sustainability of the BYHP in consideration to community commitment through community empowerment and self-determination.

Aims

In what ways does a community designed health promotion program: • Facilitate healthy lifestyle change in the Bindjareb women

and their families? • Meet the needs of the Pinjarra Bindjareb women and

provide a supportive environment for the women to engage in health promotion activities?

• Encourage community ownership of ongoing change in healthy lifestyle habits?

• Influence community action to lead to sustainability of the program?

• Make alterations to physical characteristics measured through biometric measurements?

Research Questions

• This research study will be guided by The Indigenous Research Agenda Framework (IRAF) (Smith, 2005, p.117) which conceptualises the Indigenous peoples’ current living culture.

Theoretical Framework

Self-determination

HEALING Physical

Spiritual

Psychological

Social

Collective Restoration

DECOLONISATION

Political

Social

Spiritual

Psychological

MOBILISATION

Local

Regional

National

Global

TRANSFORMATION

Psychological

Social

Political

Economic

Collective Change

SURVIVAL

urvival

DEVELOPMENT

RECOVERY

SELF-

DETERMINATION

• descriptive case study design with embedded units, allowing an ability to analyse data within, between and across the components of the intervention (Yin, 2009).

• narrative inquiry will be used within the case study design (Wells, 2011).

Methodology

• participants will be involved in a health related intervention to evaluate the effects on health outcomes (ICMJE, 2009)

• registered with the Australian & New Zealand Clinical Trials Registry – ACTRN12612000292875

Clinical Trial

• Bindjareb research associate and two Bindjareb women Elders will assist with the recruitment, data collection and analysis

• ‘yarning groups’ (focus) and interviews will be facilitated by Caroline Nilson and Karrie-Anne Kearing (Bindjareb research associate)

• participant observation and direct observation by the researcher and research associate

• biometric measurements will be recorded to track any changes made to particular physical characteristics of the participants

Data Collection

• analysis most desirable to descriptive case study

design with embedded units is pattern matching logic (Yin, 2009).

• compares predicted patterns with empirically based patterns. If the patterns coincide, internal validity of the case study is strengthened (Yin, 2009). Supported by a narrative approach (Richmond, 2002)

• Artichoke ™ database software (Fetherston, 2007) will be used

Data Analysis

• Predicative Analytical Software (PASW) Statistics 18 for Windows (2011)will be used to analyse biometric data

• Descriptive statistics will be reported as mean and standard deviation (SD) or median and interquartile range (IQR) according to normality

• Assuming normality, a one way repeated measures ANOVA will be used to measure biometric measurements change over the course of the intervention.

•Murdoch University Human Ethics Committee – Outright approval: Approval number: 2012/051

• Western Australian Aboriginal Health

Information And Ethics Committee - Pending

Ethics

• Heathway – Health Promotion Research Project Grant (outcome: October 2012)

• Smaller scale project with the support and assistance of partner health education and health promotion organisations previously mentioned

Funding

• as the sample for this study is being drawn from the two main Bindjareb kinship groups in Pinjarra it will be attenuated by circumstance.

• self selection for the study: • particular interest in the topic area of the

intervention; • they have a friend or family member who is

also participating from the same mob or kinship

Limitations

• Aboriginal research paradigm uses six core values of Reciprocity, Respect, Equality, Responsibility, Survival and Protection and Spirit and Integrity (NHMRC – NS4.7, 2007)

Aboriginal Research Paradigm The researchers will ground this research knowingly in the lives of the Pinjarra Bindjareb women as individuals and social beings, not on the theory of ideas, but on those based and supported by Nyungar forms of Kaartdijin lore. Thus, a process of ‘checking your heart’ is an element that the researchers will apply to all approaches, as a ‘good heart’ establishes good motive and benefit for all involved (Wilson, 2008, p.60).

• Australian Bureau of Statistics (ABS). (2010). National Aboriginal and Torres Strait Islander Social Survey 2008, Cat. no. 4714.0. Canberra: ABS.

• Bindon, J., Headley, E., Rissel, C., & Wade, V. (2009). Improving the health and well-being of an urban Aboriginal men’s group through a cycling promotion program. Aboriginal and Islander Health Worker Journal, 33(4), 3-5.

• Booth, M., & Okely, A. (2005). Promoting physical activity among children and adolescents: the strengths and limitations of school-based approaches. Health Promotion Journal of Australia, 16, 52-54

• Brough, M., Bond, C., & Hunt, J. (2004). Strong in the city: towards a strength-based approach in Indigenous health promotion. Health Promotion Journal of Australia, 15(3), 215-220.

• Browne, J., Laurence, S., & Thorpe, S. (2009). Acting on food insecurity in urban Aboriginal and Torres Strait Islander communities. Policy and practice interventions to improve local access and supply of nutritious food. The National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan 2000-2010. Retrieved from http://www.healthinfonet.ecu.edu.au/health-risks/nutrition/reviews/other-reviews

• Fetherston, T. (2007). Artichoke computer software. Perth: Edith Cowan University. • Government of Western Australia. Department of Indigenous Affairs (DIACOAG). (2010). Closing the gap in Indigenous life outcomes.

Retrieved from http://www.dia.wa.gov.au/PageFiles/923/DIACOAG%20Report.pdf • Jamieson, S., & Heron, B. (2009). Evaluating the effectiveness of a healthy cooking class for Indigenous youth. Aboriginal and Islander

Health Worker Journal, 33(4), 6-5. • Kiran, A., & Knights, J. (2010). Traditional Indigenous games promoting physical activity and cultural connectedness in primary schools –

cluster randomised control trial. Health Promotion Journal of Australia, 21(2), 149-151. • McLennan, V., & Khavarpour, F. (2004). Culturally appropriate health promotion: its meaning and application in Aboriginal communities.

Health Promotion Journal of Australia, 15(3), 237-239. • Nichols, F. (2010). Aboriginal recommendations for substance use intervention programs. Aboriginal & Islander Health Worker Journal,

34(3), 4-8. • Richmond, H. (2002). Learners' Lives: A Narrative Analysis. The Qualitative Report, 7(3). Retrieved from

http://www.nova.edu/ssss/QR/QR7-3/richmond.html • Smith, L. (2005). Decolonising Methodologies: Research and Indigenous Peoples. New York: Zed Books • Thompson, M. (2010). What are Indigenous Health Workers saying about their smoking status: does it prevent them from providing

tobacco information and/or quit support to the community? Aboriginal & Islander Health Worker Journal, 34(2), 3-8. • Wells, K. (2011). Narrative inquiry. London: Oxford Press. • Wilson, S. (2008). Research is Ceremony: Indigenous Research Methods. Winnipeg, Manitoba: Fernwood Publishing • Yin, R. (2009). Case study research: design and methods. (4th ed.). Thousand Oaks, California: Sage Publications

References