Promoting Success in Maternal-Child Health Programs Serving Indigenous Families: A Community-Based Participatory Research Project

Abstract

Despite investment in maternal-child programs, there has been little impact on the health outcomes of Indigenous mothers and their children, creating a need to understand how programs can be successfully implemented. Community input is essential for successful programs; however, there is little research exploring the perspectives of frontline workers providing these programs. To gain a better understanding of how to support maternal-child health program success for Indigenous families, we completed a narrative literature review, formed a partnership with a maternal-child program, and completed a scoping review. A narrative literature review was completed to identify factors of Indigenous health program success, program barriers, and examine the inclusion of frontline workers in the health program process. From the 91 peer-reviewed articles in the review, factors of success included: community engagement, cultural considerations, community ownership, and a community-based/multi-sectoral approach. Identified barriers were categorized as: contextual, resource, and community barriers. Frontline workers were found to positively influence program success, but were often left out of the health program process. We then formed a research partnership with the KidsFirst North program in Saskatchewan, Canada. Following a community-based participatory research approach, in partnership with KidsFirst North, we developed a research study to (1) to explore families’, frontline workers,’ and administrators’ perceptions of the factors that contribute to the success and barriers of a maternal-child community health program for Indigenous families; and (2) describe the current role of frontline workers within the health program process. To gain a better understanding of the factors of Indigenous maternal-child health program success, program barriers, and the role of frontline workers in the health program process, we completed a scoping review using the Arksey and O’Malley (2005) framework and informed by Levac et al. (2010). From the 45 peer-reviewed and grey articles in the scoping review, factors of success included: relationship building, cultural, knowledge transmission styles, community collaboration, program approaches, staff, and operational considerations. Barriers included: the impacts of colonization, power and governance, client and community barriers to accessing programs, physical and geographical challenges, staff, and operational deficits. Frontline workers were found to have a role in program delivery (n=45), a role in program development (n=25), and few with a role in developing program evaluations (n=6). Although KidsFirst North drove our research decisions, the completed scoping review provided support for our research focus, the research questions, methodological decisions, and situated the discussion of the KidsFirst North findings in the maternal-child health program literature. To explore families’, frontline workers,’ and administrators’ perceptions of the factors that contribute to the success and barriers of the maternal-child community health program KidsFirst North, we worked with families, frontline workers, and administrators involved with KidsFirst North. From September 2019 to January 2020, data was collected through in-person meetings, focus groups, and semi-structured interviews with KidsFirst North families (n=9), frontline workers (n=18), and administrators (n=7). Through analyzing the data via the Collective Consensual Data Analytic Procedure (CCDAP), the identified factors of program success included: the importance of staff, community events, and the integration of culture in the program. Program barriers included: jurisdictional policy that negatively impacted frontline workers; a lack of father inclusion in program activities; and community challenges. All frontline workers had a role in program delivery, most reported involvement in program development and planning, and approximately half were included in program evaluation. Both the narrative literature review and scoping review contributed to our research by providing support for our research focus, informing our work with KidsFirst North, and situating our findings within the current literature. Factors of success and barriers from the KidsFirst North project have illustrated elements to build on and areas to address in public health program planning and evaluation of maternal-child health programs that serve Indigenous families. KidsFirst North has demonstrated ways a contemporary maternal-child health program can utilize frontline workers outside of program delivery to influence all aspects of the health program process. Contributing to the evidence base of maternal-child programs for Indigenous families may help foster the success of public health programs, inform the role of frontline workers in the health program process, and positively impact the health of Indigenous children and families.