Supporting healthy lifestyles for First Nations women and communities through co-design: lessons and early findings from remote Northern Australia.

Frontiers in clinical diabetes and healthcare Pub Date : 2024-05-28 eCollection Date: 2024-01-01 DOI:10.3389/fcdhc.2024.1356060
Tara Dias, Diana MacKay, Karla Canuto, Jacqueline A Boyle, Heather D'Antoine, Denella Hampton, Kim Martin, Jessica Phillips, Norlisha Bartlett, H David Mcintyre, Sian Graham, Sumaria Corpus, Christine Connors, Leisa McCarthy, Renae Kirkham, Louise J Maple-Brown
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Abstract

Background: The period before, during, and after pregnancy presents an opportunity to reduce diabetes-related risks, which in Australia disproportionately impact Aboriginal and Torres Strait Islander women. Collaboration with Aboriginal and Torres Strait Islander women/communities is essential to ensure acceptability and sustainability of lifestyle modifications. Using a novel co-design approach, we aimed to identify shared priorities and potential lifestyle strategies. We also reflected on learnings from this approach.

Methods: We conducted 11 workshops and 8 interviews at two sites in Australia's Northern Territory (Central Australia and Top End), using experience-based co-design (EBCD) and incorporating principles of First Nations participatory research. Workshops/interviews explored participant' experiences and understanding of diabetes in pregnancy, contextual issues, and potential lifestyle strategies. Participants included three groups: 1) Aboriginal and Torres Strait Islander women of reproductive age (defined as aged 16-45 years); 2) Aboriginal and Torres Strait Islander community members; and 3) health/community services professionals. The study methodology sought to amplify the voices of Aboriginal women.

Findings: Participants included 23 women between ages 16-45 years (9 with known lived experience of diabetes in pregnancy), 5 community members and 23 health professionals. Key findings related to identified priority issues, strategies to address priorities, and reflections on use of EBCD methodology. Priorities were largely consistent across study regions: access to healthy foods and physical activity; connection to traditional practices and culture; communication regarding diabetes and related risks; and the difficulty for women of prioritising their health among competing priorities. Strategies included implementation of a holistic women's program in Central Australia, while Top End participants expressed the desire to improve nutrition, peer support and community awareness of diabetes. EBCD provided a useful structure to explore participants' experiences and collectively determine priorities, while allowing for modifications to ensure co-design methods were contextually appropriate. Challenges included the resource-intensive nature of stakeholder engagement, and collaborating effectively with services and communities when researchers were "outsiders".

Conclusions: A hybrid methodology using EBCD and First Nations participatory research principles enabled collaboration between Aboriginal women, communities and health services to identify shared priorities and solutions to reduce diabetes-related health risks. Genuine co-design processes support self-determination and enhance acceptability and sustainability of health strategies.

通过共同设计支持原住民妇女和社区的健康生活方式:澳大利亚北部偏远地区的经验教训和早期发现。
背景:怀孕前、怀孕期间和怀孕后是降低糖尿病相关风险的良机,而在澳大利亚,糖尿病对土著居民和托雷斯海峡岛民妇女的影响尤为严重。与土著居民和托雷斯海峡岛民妇女/社区的合作对于确保改变生活方式的可接受性和可持续性至关重要。我们采用新颖的共同设计方法,旨在确定共同的优先事项和潜在的生活方式策略。我们还反思了从这种方法中学到的知识:我们在澳大利亚北部地区的两个地点(澳大利亚中部和顶端地区)开展了 11 次研讨会和 8 次访谈,采用了基于经验的共同设计(EBCD),并融入了原住民参与式研究的原则。研讨会/访谈探讨了参与者的经验和对妊娠糖尿病的理解、背景问题以及潜在的生活方式策略。参与者包括三个群体:1)原住民和托雷斯海峡岛民育龄妇女(定义为 16-45 岁);2)原住民和托雷斯海峡岛民社区成员;3)健康/社区服务专业人员。研究方法力求扩大土著妇女的声音:参与者包括 23 名年龄在 16-45 岁之间的妇女(其中 9 人有已知的妊娠糖尿病生活经历)、5 名社区成员和 23 名卫生专业人员。主要发现涉及已确定的优先问题、解决优先问题的策略以及对使用 EBCD 方法的反思。各研究地区的优先事项基本一致:获得健康食品和体育锻炼的机会;与传统习俗和文化的联系;有关糖尿病及相关风险的沟通;以及妇女难以在相互竞争的优先事项中优先考虑自己的健康。策略包括在澳大利亚中部地区实施一项妇女综合计划,而顶端地区的参与者则表示希望改善营养、同伴支持和社区对糖尿病的认识。EBCD 为探索参与者的经验和集体确定优先事项提供了一个有用的结构,同时允许进行修改,以确保共同设计方法适合具体情况。面临的挑战包括利益相关者参与的资源密集性,以及当研究人员是 "局外人 "时与服务机构和社区的有效合作:采用 EBCD 和原住民参与式研究原则的混合方法使原住民妇女、社区和医疗服务机构能够开展合作,确定共同的优先事项和解决方案,以降低与糖尿病相关的健康风险。真正的共同设计过程支持自决,提高健康战略的可接受性和可持续性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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