title: Empowering families by engaging and relating Murri way: a grounded theory study of the implementation of the Cape York Baby Basket program.
abstract: BACKGROUND
  Evaluating program outcomes without considering how the program was implemented can cause misunderstandings and inefficiencies when initiating program improvements. In conjunction with a program evaluation, reported elsewhere, this paper theorises the process of implementing an Indigenous Australian maternal and child health program. The Baby Basket program was developed in 2009 for the remote Cape York region and aimed to improve the attendance and engagement of Indigenous women at antenatal and postnatal clinics through providing three baskets of maternal and baby goods and associated health education.
  
  
  METHODS
  Constructivist grounded theory methods were used to generate and analyse data from qualitative interviews and focus groups with Indigenous women who received the baskets, their extended family members, and healthcare workers who delivered them. Data was coded in NVivo with concepts iteratively compared until higher order constructs and their relationships could be modelled to explain the common purpose for participants, the process involved in achieving that purpose, key strategies, conditions and outcomes. Theoretical terms are italicised.
  
  
  RESULTS
  Program implementation entailed empowering families through a process of engaging and relating Murri (Queensland Indigenous) way. Key influencing conditions of the social environment were the remoteness of communities, keeping up with demand, families' knowledge, skills and roles and organisational service approaches and capacities. Engaging and relating Murri way occurred through four strategies: connecting through practical support, creating a culturally safe practice, becoming informed and informing others, and linking at the clinic. These strategies resulted in women and families taking responsibility for health through making healthy choices, becoming empowered health consumers and advocating for community changes.
  
  
  CONCLUSIONS
  The theoretical model was applied to improve and revise Baby Basket program implementation, including increased recognition of the importance of empowering families by extending the home visiting approach up to the child's third birthday. Engaging and relating Murri way was strengthened by formal recognition and training of Indigenous health workers as program leaders. This theoretical model of program implementation was therefore useful for guiding program improvements, and could be applicable to other Indigenous maternal and child health programs.
authors.affiliation: The Cairns Institute and College of Public Health and Tropical Medicine, James Cook University, PO Box 6811, Cairns, QLD 4870, Australia. janya.mccalman@jcu.edu.au.
authors.forename: Janya
authors.initials: J
authors.lastname: McCalman
authors.affiliation: Health Research Economist, Hunter Medical Research Institute and University of Newcastle, Locked Bag 1000, New Lambton, 2305, NSW, Australia. Andrew.searles@hmri.com.au.
authors.forename: Andrew
authors.initials: A
authors.lastname: Searles
authors.affiliation: The Cairns Institute and College of Public Health and Tropical Medicine, James Cook University, PO Box 6811, Cairns, QLD 4870, Australia. roxanne.bainbridge@jcu.edu.au.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Bainbridge
authors.affiliation: Apunipima Cape York Health Council, PO Box 12045, Westcourt, 4870, QLD, Australia. Rachael.ham@apunipima.org.au.
authors.forename: Rachael
authors.initials: R
authors.lastname: Ham
authors.affiliation: Apunipima Cape York Health Council, PO Box 12045, Westcourt, 4870, QLD, Australia. Jacki.mein@apunipima.org.au.
authors.forename: Jacki
authors.initials: J
authors.lastname: Mein
authors.affiliation: Apunipima Cape York Health Council, PO Box 12045, Westcourt, 4870, QLD, Australia. Johanna.neville@apunipima.org.au.
authors.forename: Johanna
authors.initials: J
authors.lastname: Neville
authors.affiliation: Centre of Research Excellence in Prevention of Chronic Conditions, James Cook University, PO Box 6811, Cairns, 4870, QLD, Australia. sandra.campbell2@jcu.edu.au.
authors.forename: Sandra
authors.initials: S
authors.lastname: Campbell
authors.affiliation: The Cairns Institute and College of Arts and Society and Education, James Cook University, PO Box 6811, Cairns, 4870, QLD, Australia. komla.tsey@jcu.edu.au.
authors.forename: Komla
authors.initials: K
authors.lastname: Tsey
mesh_terms: D000328:Adult; D065246:Culturally Competent Care / Q000379:methods*; D005190:Family / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D066296:Grounded Theory; D006266:Health Education / Q000379:methods; D006303:Health Services, Indigenous / Q000592:standards*; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008427:Maternal Health Services / Q000379:methods*; D011209:Power, Psychological; D011247:Pregnancy; D015397:Program Evaluation / Q000379:methods; D036301:Qualitative Research; D011793:Queensland / Q000208:ethnology