From Consultation to Application: Practical Solutions for Improving Maternal and Neonatal Outcomes for Adolescent Aboriginal Mothers at a Local Level
Abstract
:1. Introduction
1.1. Setting the Scene
1.1.1. Teen Pregnancy in Western Australia
1.1.2. Context of the Geographical Environment on Access to Health
1.1.3. Context of Adolescent Pregnancy
Why Teenage Pregnancy Occurs?
Supporting Adolescents Regardless of Causal Factors
2. Method
- (1)
- The Young Aboriginal Women’s Voices on Pregnancy Care project was conducted as a descriptive qualitative research study with data collection undertaken using a culturally sensitive, semi-structured interview schedule incorporating a personal and conversational manner known as yarning [52]. Data was analysed using standard qualitative analysis techniques, identifying themes and sub-topics. A total of 84 individual or group interviews were conducted with 28 women in the target group (16–21 years) and 56 senior and elder Aboriginal women and non-Aboriginal service providers in locations across WA, including six out of the eight health regions. The field researchers were an Aboriginal cultural consultant highly experienced in working with young Aboriginal mothers in her role as an Aboriginal Health Worker and a non-Aboriginal researcher with extensive experience in conducting interviews with Aboriginal people. Study approval was granted by the Western Australian Aboriginal Health Ethics Committee (WAAHEC) (2013:443) and the Western Australian Country Health Service (WACHS) (2013:05), Women’s and Newborns Health Service (2013-038EW), and North and South Metropolitan Health Services Human Research Ethics Committees (HREC) (reciprocal approval). Research approval was also granted by the Kimberley Aboriginal Health Planning Forum Research Sub-Committee.
- (2)
- The Aboriginal Women’s Patient Journeys project was a feasibility study to determine what an integrated model of care for Aboriginal women in WA during pregnancy might include. Over 140 health professionals from 53 different organizations across WA participated in either focus groups or individual interviews. To identify themes, each focus group or interview printed record and taped transcript was analysed and common themes and topics were then translated into a matrix to allow comparison across regions. These matrices were reviewed by the research team for confirmation of content and to conclude what similarities and contrasts were apparent across regions. The data was analysed according to standard qualitative data analysis protocols. Ethics approval for this project was obtained from WAAHEC (2013:500) and WACHS HREC (2013:21). The King Edward Memorial Hospital HREC committee assessed the project as a quality improvement project, thus it was entered into Governance Evidence Knowledge Outcomes (GEKO) Safety and Quality database as a quality audit. Express written permission was obtained from the Chief Executive Officer or Board for every ACCHS or AMS involved.
2.1. Applying the Research Findings
- Young Aboriginal women need pregnancy care that supports them during a vulnerable time in their lives and respects their choice, privacy and confidentiality at all times and in all service settings.
- Aboriginal family relationships are crucial to encouraging early and ongoing antenatal engagement by young Aboriginal women. Services need to build relationships with influential local women Elders/community members to support knowledge exchange of pregnancy and childbirth and local cultural practices; dissemination of information about pregnancy care and available services throughout communities; and assistance with identification of young pregnant women to encourage engagement with health care.
- Dedicated spaces are required where women can come together safely to “yarn” (talk).
- Culturally safe models of care (with continuity of carer) provided by culturally competent health professionals and other health service staff are needed to maintain relationships with young pregnant women.
- Adolescents moving between communities were viewed as being most at risk of not accessing antenatal care. Women who need to relocate to give birth are at risk of falling through service gaps and having negative pregnancy and birthing experiences as a result.
- A documented patient relocation pathway is required to support young Aboriginal women to feel safe. This includes securing appropriate transport from and back to home communities; assistance for escort/support people to be present for the duration of the pregnant woman’s relocation (including changes of support people over that time); accommodation options and social support services at the relocation site, including access to an Aboriginal Liaison Officer/Community Care or Health Worker; detailed information about the cultural practices/expectations of individual Aboriginal women forwarded by the home community health service staff for the information of health service staff at the relocation site.
2.2. Identifying Actions for Implementation
3. Discussion
4. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Pregnancy Topic | Summary of Participant Identified Strategies |
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Pre-Pregnancy Participants were asked what they understood about the local context in which service providers worked and who to speak with to develop knowledge of the community. |
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Pregnancy Participants were asked to consider what was needed to engage with young women early in pregnancy. |
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Relocation/Preparing to Birth Participants were asked to consider how they might go about planning relocation in consultation with the young woman. |
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Discharge/Relocation to Home Community Participants were asked to consider how they might go about planning and documenting a discharge for a young women for her return to the community. |
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Reibel, T.; Wyndow, P.; Walker, R. From Consultation to Application: Practical Solutions for Improving Maternal and Neonatal Outcomes for Adolescent Aboriginal Mothers at a Local Level. Healthcare 2016, 4, 90. https://doi.org/10.3390/healthcare4040090
Reibel T, Wyndow P, Walker R. From Consultation to Application: Practical Solutions for Improving Maternal and Neonatal Outcomes for Adolescent Aboriginal Mothers at a Local Level. Healthcare. 2016; 4(4):90. https://doi.org/10.3390/healthcare4040090
Chicago/Turabian StyleReibel, Tracy, Paula Wyndow, and Roz Walker. 2016. "From Consultation to Application: Practical Solutions for Improving Maternal and Neonatal Outcomes for Adolescent Aboriginal Mothers at a Local Level" Healthcare 4, no. 4: 90. https://doi.org/10.3390/healthcare4040090