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Reflecting on KooriDirected Health Promotion in the Goulburn Valley

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Title: Reflecting on KooriDirected Health Promotion in the Goulburn Valley

1
Reflecting on Koori-Directed Health Promotion in
the Goulburn Valley

Joyce Doyle, Rachel Reilly, Brad Firebrace,
Denise Morgan-Bulled, Margaret Cargo, Kevin
Rowley, for the Heart Health Project Steering
Committee
Onemda VicHealth Koori Health Unit, Centre for
Health and Society, School of Population Health,
The University of Melbourne, Melbourne VIC
Rumbalara Aboriginal Co-operative, Mooroopna VIC
Rumbalara Football Netball Club, Shepparton VIC
Viney Morgan Aboriginal Medical Service,
Cummeragunja NSW
McGill University, Montreal, Canada.

2
Acknowledgements

The Heart Health Project Steering Committee
Paul Briggs (RFNC), Sharon Charles (RAC), Julie
Calleja, Rochelle Patten (VMAMS), Sharon
Lawrence, Roland Watson, Jane Winter (DHS).
This work was funded by the Department of Human
Services Victoria Public Health Research scheme.
RR is supported by an NHMRC Program Grant
(320860). KR was a VicHealth Public Health
Research Fellow
Warundjeri Elders and Traditional Owners

3
Outline

Setting
Background to the project
Findings and recommendations of the Heart Health
Project
Recent health promotion in the Goulburn Valley
Reflection and evaluation

4
Setting

The Koori population of the Goulburn Valley is
1500 and 3000, the states largest Aboriginal
community outside Melbourne.
The population is mainly spread across three
regional centres and an Aboriginal township,
Cummeragunja, on the New South Wales side of the
Murray River.
These are the traditional lands of the Yorta
Yorta and Bangarang Nations
As in other states, cardiovascular disease (CVD)
is probably the major contributor to the high
premature mortality for Aboriginal People in
Victoria and NSW.

5
Program Partners

This program builds on previous collaborative
work on The Heart Health Project between
Rumbalara Aboriginal Co-operative
Viney-Morgan Aboriginal Medical Service
Rumbalara Football Netball Club
Onemda VicHealth Koori Health Unit

6
Figure 2 Aboriginal and Torres Strait Islander
Peoples Values Relevant to Health Research Ethics
(National Health and Medical Research Council,
2003b, p.9).
7
Research Framework

Participatory Action Research (PAR)

8
The Heart Health Project

Aim
To design and evaluate interventions to improve
biomedical, environmental and psychosocial
factors that influence health behaviours and
outcomes.
- screening biomedical measures
questionnaire
- health promotion interventions

9
The Heart Health Project

A questionnaire was developed with consideration
of the breadth of factors affecting CVD risk,
covering
- diet, exercise and smoking
- barriers to healthy diet and
exercise behaviours
- smoking
- oral health
- access to Koori and
mainstream services
- social and emotional wellbeing
We report risk factor results from a survey
sample of employees of Indigenous organisations
(n66 69 response rate 20 men, 46 women age
range 18-62 years).

10
(No Transcript)
11
Findings and Recommendations

Indicated that the health behaviour of community
members relating to diet and physical exercise
were generally not in line with the national
guidelines
(Australian Government Department of Health and
Ageing, 1999 National Health and Medical
Research Council, 2003a, 2006).
Recommended the development of community-directed,
culturally-aligned programs to promote
improvements in nutrition and physical exercise
(Reilly, Doyle, Rowley, 2007 The Heart
Health Project Steering Committee, 2007).
Significant improvements in diet and nutrition
have been achieved through community-directed
changes in store management and health promotion
activities
(Lee et al.,1995 Rowley et al., 2001)

12
Aims

To evaluate nutrition and physical activity
guidelines from the perspectives of Koori
community members with a view to creating
guidelines that are more relevant to Kooris
To devise relevant, community-directed health
promotion interventions to improve nutrition and
exercise
To increase the capacity of local Koori
researchers to devise and evaluate health
promotion interventions and
To increase the capacity of the university
researchers and funding body in working
appropriately with community
CAPACITY EXCHANGE

13
GV Health Promotion Program

Researcher training- Health Summer School
Hungry for Victory
RFNC Canteen Fruit Share Program
Developing Nutrition Guidelines
Cummeragunja womens wellbeing group
10-Week Body Challenge

14
Researcher Training

Health Summer School
NUTRITION PROGRAM PLANNING AND EVALUATION FOR
INDIGENOUS COMMUNITY HEALTH (QUT)
Attended by three Koori researchers
Ideas for health promotion interventions
workshopped
Outcomes
The participants were struck by the commonality
of problems across vastly different community
settings
Participants became more aware of their own
expertise
Participants realised that the Rumbalara Football
Netball Club (RFNC) provided a forum and ready
audience for intervention. This led to the
development of the first Health Promotion
intervention.

15
Focus Groups

Aim to gauge responses the mainstream
guidelines, compare these to Aboriginal-specific
guidelines created in other communities and
devise Koori-focused guidelines for the local
community.
Themes arising in the focus groups related to
Budget
Convenience/Access
Busy lifestyle
Household
Health and fitness
Knowledge

16
Cummeragunja Womens Wellbeing Group

Participants advocated for this group
Not a focus group
A social group where health was discussed
Facilitated by health workers from RFNC and Rumba
Co-op
Ran over 4 weeks
Responded to specific concerns of participants
regarding barriers to good health
Activities included using a pedometer, collecting
bush tucker, crafts and discussion.

17
Reflection and Evaluation

Lack of systematic quantitative evaluation limits
our ability to demonstrate effectiveness of
programs using conventional measures.
Project workers completed surveys for each
activities and participated in interviews- based
on Ecological Analysis.
Activities designed to fit a specific local
context and may not be usefully generalised to
other communities. However, many issues are
common across communities

18
Facilitators of Implementation of Activities as
assessed by project workers
19
Barriers to implementation of activities as
assessed by project workers
20
Survey Data

The degree to which an activity was deemed
successful by project workers corresponded to the
degree to which it
Was aligned with community values
Used knowledge of the local community.
Valued existing social structures and systems.
Was organised within a Koori cultural framework.
Eg activities that foster social connectedness vs
questionnaires
Imposition of non-Koori ideas (eg the need for
guidelines) vs. community-initiated ideas (eg
garden, womens wellbeing group)

21
Conclusion

Support for collaborative, participatory
approaches to research and health promotion
Partnerships involve
a continual negotiation of roles and competing
values (eg. trainer/trainee rigour/flexibility)
Clear and respectful communication
Capacity exchange universities and funding
bodies as partners

22
References

Australian Government Department of Health and
Ageing, (1999) An Active Way to BetterHealth
Physical Activity Guidelines forAustralian
Adults Australian Government Department of
Health and Ageing.
Australian Government Department of Health and
Ageing and the National Health and Medical
Research Council. (2006). Food for Health
Dietary Guidelines for Australians, A Guide for
Healthy Eating Australian Government Department
of Health and Ageing.
Lee, A., Bronson, A., Yarmirr, D., ODea, K and
Matthews, J. (1995). Sustainability of a
successful health and nutrition program in a
remote Aboriginal community. Medical Journal of
Australia,162, 632-635.
Reilly, R., Doyle, J. and Rowley, K. (2007).
Koori community-directed health promotion in the
Goulburn Valley. Australian Community
Psychologist, 19(1), 40-46
Rowley, K., Su, Qing, Cincotta, M., Skinner, M.,
Skinner, K., Pindan, B., White, G. and ODea, K.
(2001). Improvements in circulating cholesterol,
antioxidants and homocysteine after dietary
intervention in an Australian Aboriginal
community. American Journal of Clinical Nutrition
74, 442-448
The Heart Health Project Steering Committee
(2007). A Collaborative Cardiovascular Health
Program for Aboriginal an Torres Strait Islander
People in the Goulburn-Murray Region Development
and Risk Factor Screening at Indigenous Community
Organisations. Australian Journal of Primary
Health, 13 (1), 9-17