Reflecting on Koori-Directed Health Promotion in the Goulburn Valley

1. Reflecting on Koori-Directed Health Promotion in the Goulburn Valley Joyce Doyle, Rachel Reilly, Brad Firebrace, Denise Morgan-Bulled, Margaret Cargo, Kevin Rowley, for the Heart Health Project Steering Committee Onemda VicHealth Koori Health Unit, Centre for Health and Society, School of Population Health, The University of Melbourne, Melbourne VIC; Rumbalara Aboriginal Co-operative, Mooroopna VIC; Rumbalara Football Netball Club, Shepparton VIC; Viney Morgan Aboriginal Medical Service, Cummeragunja NSW; McGill University, Montreal, Canada.

2. Acknowledgements The Heart Health Project Steering Committee: Paul Briggs (RFNC), Sharon Charles (RAC), Julie Calleja, Rochelle Patten (VMAMS), Sharon Lawrence, Roland Watson, Jane Winter (DHS). This work was funded by the Department of Human Services Victoria Public Health Research scheme. RR is supported by an NHMRC Program Grant (#320860). KR was a VicHealth Public Health Research Fellow Warundjeri Elders and Traditional Owners

3. Outline Setting Background to the project Findings and recommendations of the Heart Health Project Recent health promotion in the Goulburn Valley Reflection and evaluation

4. Setting The Koori population of the Goulburn Valley is 1500 and 3000, the state�s largest Aboriginal community outside Melbourne. The population is mainly spread across three regional centres and an Aboriginal township, Cummeragunja, on the New South Wales side of the Murray River. These are the traditional lands of the Yorta Yorta and Bangarang Nations As in other states, cardiovascular disease (CVD) is probably the major contributor to the high premature mortality for Aboriginal People in Victoria and NSW.

5. Program Partners This program builds on previous collaborative work on The Heart Health Project between: Rumbalara Aboriginal Co-operative Viney-Morgan Aboriginal Medical Service Rumbalara Football Netball Club Onemda VicHealth Koori Health Unit

7. Research Framework Participatory Action Research (PAR)

8. The Heart Health Project Aim: To design and evaluate interventions to improve biomedical, environmental and psychosocial factors that influence health behaviours and outcomes. - screening: biomedical measures & questionnaire - health promotion interventions

9. The Heart Health Project A questionnaire was developed with consideration of the breadth of factors affecting CVD risk, covering: - diet, exercise and smoking - barriers to healthy diet and exercise behaviours - smoking - oral health - access to Koori and mainstream services - social and emotional wellbeing We report risk factor results from a survey sample of employees of Indigenous organisations (n=66; 69% response rate; 20 men, 46 women; age range 18-62 years).

11. Findings and Recommendations Indicated that the health behaviour of community members relating to diet and physical exercise were generally not in line with the national guidelines (Australian Government Department of Health and Ageing, 1999; National Health and Medical Research Council, 2003a, 2006). Recommended the development of community-directed, culturally-aligned programs to promote improvements in nutrition and physical exercise (Reilly, Doyle, & Rowley, 2007; The Heart Health Project Steering Committee, 2007). Significant improvements in diet and nutrition have been achieved through community-directed changes in store management and health promotion activities (Lee et al.,1995; Rowley et al., 2001)

12. Aims To evaluate nutrition and physical activity guidelines from the perspectives of Koori community members with a view to creating guidelines that are more relevant to Kooris To devise relevant, community-directed health promotion interventions to improve nutrition and exercise To increase the capacity of local Koori researchers to devise and evaluate health promotion interventions; and To increase the capacity of the university researchers and funding body in working appropriately with community = CAPACITY EXCHANGE ..

13. GV Health Promotion Program Researcher training- Health Summer School Hungry for Victory RFNC Canteen Fruit Share Program Developing Nutrition Guidelines Cummeragunja women�s wellbeing group 10-Week Body Challenge

14. Researcher Training Health Summer School: NUTRITION: PROGRAM PLANNING AND EVALUATION FOR INDIGENOUS COMMUNITY HEALTH (QUT) Attended by three Koori researchers Ideas for health promotion interventions workshopped Outcomes: The participants were struck by the commonality of problems across vastly different community settings Participants became more aware of their own expertise Participants realised that the Rumbalara Football Netball Club (RFNC) provided a forum and ready audience for intervention. This led to the development of the first Health Promotion intervention.

15. Focus Groups Aim: to gauge responses the �mainstream� guidelines, compare these to Aboriginal-specific guidelines created in other communities and devise Koori-focused guidelines for the local community. Themes arising in the focus groups related to: Budget Convenience/Access Busy lifestyle Household Health and fitness Knowledge

16. Cummeragunja Women�s Wellbeing Group Participants advocated for this group Not a focus group A social group where health was discussed Facilitated by health workers from RFNC and Rumba Co-op Ran over 4 weeks Responded to specific concerns of participants regarding barriers to good health Activities included using a pedometer, collecting bush tucker, crafts and discussion.

17. Reflection and Evaluation Lack of systematic quantitative evaluation limits our ability to demonstrate effectiveness of programs using conventional measures. Project workers completed surveys for each activities and participated in interviews- based on �Ecological Analysis�. Activities designed to fit a specific local context and may not be usefully generalised to other communities. However, many issues are common across communities

18.

20. Survey Data The degree to which an activity was deemed successful by project workers corresponded to the degree to which it: Was aligned with community values Used knowledge of the local community. Valued existing social structures and systems. Was organised within a Koori cultural framework. Eg activities that foster social connectedness vs questionnaires Imposition of non-Koori ideas (eg the need for guidelines) vs. community-initiated ideas (eg garden, women�s wellbeing group)

21. Conclusion Support for collaborative, participatory approaches to research and health promotion Partnerships involve a continual negotiation of roles and competing values (eg. trainer/trainee; rigour/flexibility) Clear and respectful communication Capacity exchange: universities and funding bodies as partners

22. References Australian Government Department of Health and Ageing, (1999) An Active Way to BetterHealth: Physical Activity Guidelines forAustralian Adults: Australian Government Department of Health and Ageing. Australian Government Department of Health and Ageing and the National Health and Medical Research Council. (2006). Food for Health: Dietary Guidelines for Australians, A Guide for Healthy Eating: Australian Government: Department of Health and Ageing. Lee, A., Bronson, A., Yarmirr, D., O�Dea, K and Matthews, J. (1995). Sustainability of a successful health and nutrition program in a remote Aboriginal community. Medical Journal of Australia,162, 632-635. Reilly, R., Doyle, J. and Rowley, K. (2007). Koori community-directed health promotion in the Goulburn Valley. Australian Community Psychologist, 19(1), 40-46 Rowley, K., Su, Qing, Cincotta, M., Skinner, M., Skinner, K., Pindan, B., White, G. and O�Dea, K. (2001). Improvements in circulating cholesterol, antioxidants and homocysteine after dietary intervention in an Australian Aboriginal community. American Journal of Clinical Nutrition 74, 442-448 The Heart Health Project Steering Committee (2007). A Collaborative Cardiovascular Health Program for Aboriginal an Torres Strait Islander People in the Goulburn-Murray Region: Development and Risk Factor Screening at Indigenous Community Organisations. Australian Journal of Primary Health, 13 (1), 9-17