title: Supporting aboriginal knowledge and practice in health care: lessons from a qualitative evaluation of the strong women, strong babies, strong culture program.
abstract: BACKGROUND
  The Strong Women, Strong Babies, Strong Culture Program (the Program) evolved from a recognition of the value of Aboriginal knowledge and practice in promoting maternal and child health (MCH) in remote communities of the Northern Territory (NT) of Australia. Commencing in 1993 it continues to operate today. In 2008, the NT Department of Health commissioned an evaluation to identify enabling factors and barriers to successful implementation of the Program, and to identify potential pathways for future development. In this paper we focus on the evaluation findings related specifically to the role of Aborignal cultural knowledge and practice within the Program.
  
  
  METHODS
  A qualitative evaluation utilised purposive sampling to maximise diversity in program history and Aboriginal culture. Semi-structured, in-depth interviews with 76 participants were recorded in their preferred language with a registered Interpreter when required. Thematic analysis of data was verified or modified through further discussions with participants and members of the evaluation team.
  
  
  RESULTS
  Although the importance of Aboriginal knowledge and practice as a fundamental component of the Program is widely acknowledged, there has been considerable variation across time and location in the extent to which these cultural dimensions have been included in practice. Factors contributing to this variation are complex and relate to a number of broad themes including: location of control over Program activities; recognition and respect for Aboriginal knowledge and practice as a legitimate component of health care; working in partnership; communication within and beyond the Program; access to transport and working space; and governance and organisational support.
  
  
  CONCLUSIONS
  We suggest that inclusion of Aboriginal knowledge and practice as a fundamental component of the Program is key to its survival over more than twenty years despite serious challenges. Respect for the legitimacy of Aboriginal knowledge and practice within health care, a high level of community participation and control supported through effective governance and sufficient organisational commitment as well as competence in intercultural collaborative practice of health staff are critical requirements for realising the potential for cultural knowledge and practice to improve Aboriginal health outcomes.
authors: Research Centre for Health and Wellbeing, Charles Darwin University, Ellengowan Drive, Darwin, Northern Territory, Australia. anne.lowell@cdu.edu.au.
authors: Anne
authors: A
authors: Lowell
authors: Midwifery Research Unit, Mater Research Institute, School of Nursing and Midwifery, University of Queensland, Brisbane, Queensland, Australia. sue.kildea@mater.uq.edu.au.
authors: Sue
authors: S
authors: Kildea
authors: Strong Women, Strong Babies, Strong Culture Program Coordinator, Department of Health, Northern Territory Government, Darwin, NT, Australia. Marlene.liddle@nt.gov.au.
authors: Marlene
authors: M
authors: Liddle
authors: Strong Women, Strong Babies, Strong Culture Program Coordinator, Department of Health, Northern Territory Government, Darwin, NT, Australia. Barbara.Cox@nt.gov.au.
authors: Barbara
authors: B
authors: Cox
authors: Department of Health, Northern Territory Government, Darwin, NT, Australia. Barbara.Paterson@outlook.com.
authors: Barbara
authors: B
authors: Paterson
mesh_terms: D001315:Australia; D002648:Child; D000067576:Child Health; D002662:Child Health Services / Q000458:organization & administration*; D054521:Cultural Competency; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006303:Health Services, Indigenous / Q000458:organization & administration / Q000592:standards; D006801:Humans; D000068101:Maternal-Child Health Services / Q000458:organization & administration / Q000592:standards; D011247:Pregnancy; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000379:methods; D058996:Quality Improvement / Q000458:organization & administration*; D016387:Women's Health; D014932:Women's Health Services / Q000458:organization & administration*
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