Culturally appropriate methods for enhancing the participation of Aboriginal Australians in health-promoting programs

ISSUE ADDRESSED: This study investigated the application of an educational health promotion program, the Stanford Chronic Disease Self-Management Program (CDSM), within three Queensland Aboriginal (Murri) communities (rural, regional and urban). METHODS: A participant-observation approach was used and qualitative data was collected through interviews and focus groups. A total of 39 people participated, al of whom had been exposed to the program in different ways (i.e. leaders, health professionals, Elders who sponsored the program) during its recent deployment in their communities. RESULTS: Across all three regions, Aboriginal engagement in the program was found to be influenced by core factors that are well known and reflect our general understanding about Aboriginal history (e.g. the impact of negative medica interactions, the lack of cultural competence, the use of culturally insensitive methods of service delivery, the collectivity of Murri life and the holistic concept of health). However, a more important finding was that irrespective of these broad factors, the acceptability of the program in each community depended on the extent to which it had embraced and espoused several localised processes. The impact and nature of these processes differed across each region. CONCLUSIONS: Four local processes reflected the unique characteristics and profile of each community.They included the need to be responsive to local systems and structures, to incorporate local cultural traditions and knowledge bases, to use locally accepted forms of cultural communication, and to facilitate oca community participation and leadership in the program. Importantly, these factors determined the experience of the program within each community, ultimately influencing its acceptability, effectiveness and sustainability.