Person, Provider, Practice and Policy—P4: A framework for two-way learning and aboriginal community-led health promotion and evaluation

Research in Aboriginal communities starts where the community is at and works collaboratively and culturally responsively to the priorities and rhythms of the communities. The See Treat Prevent (SToP) Trial is the first clinical study to incorporate a holistic approach to reducing skin infections. This approach enabled the worldviews of Aboriginal people at the local community level to govern the empowerment approach underpinning the co-design of healthy skin resources and an evaluation framework. This manuscript reports the process of working on Country with Aboriginal communities to facilitate the restoration of Indigenous knowledge systems that have historically been excluded from health research, programs and policies. Yarning methodology was a approach for embedding Aboriginal worldviews within the Person, Provider, Practice and Policy (P4) evaluation framework showing the bi-directional interrelationships between community members, providers, and policies that affect health and wellbeing of Aboriginal people at the local community level. Importantly, the P4 model is a practical framework for considering the impact of policy and distance in real-world circumstances. Addressing the high prevalence of skin infections in Aboriginal children living in Kimberley communities requires empowerment approaches to include the voices of Aboriginal people living on Country. Doing so should not be a universal approach but a specific approach embedding local community culture and context to enable self-determination for Aboriginal communities. Health interventions that do not allow for transparency between community interrelationships will be difficult to implement or capture the important system inequities that often go unnoticed. It is anticipated that P4 can provide real opportunities for understanding health behaviours, not only at the Person level but also at the Provider, Practice and Policy levels to influence change.