Skip to main content
SpringerLink
Log in

‘Making a Difference’: A New Care Paradigm for Pregnant and Parenting Aboriginal People

  • Published:
Canadian Journal of Public Health Aims and scope Submit manuscript

Abstract

Objective

To describe community-based stakeholders’ views of how safe and responsive care “makes a difference” to health and well-being for pregnant and parenting Aboriginal people. Community-based stakeholders included community members, providers of health and social care, and health care and community leaders.

Methods

A postcolonial standpoint, participatory research principles and a case-study design were used to investigate two Aboriginal organizations’ experiences improving care for pregnant and parenting Aboriginal people. Data were collected through researcher field notes, exploratory interviews and small group discussions with purposively selected community-based leaders, members and providers. Data were analyzed using an interpretive descriptive method.

Results

Community participants’ views of “making a difference” emphasized: recognizing relevant outcomes of care; acknowledging progress over time; and using a strengths-based approach in which providers appreciate individuals’ efforts and the challenges of their contextual circumstances.

Discussion

“Making a difference” to pregnant and parenting Aboriginal people would facilitate Aboriginal peoples’ efforts to tackle the deeply embedded socio-historical determinants of well-being and capacity, and thus shift priorities for care upstream to focus on such determinants. Such a paradigm for care would integrate multiple perspectives on desirable outcomes within local frameworks based on values and priorities of Aboriginal parents, while also incorporating the benefits and wisdom of existing yet further downstream approaches to care.

Conclusion

Design and evaluation of care based on community values and priorities and using a strengths-based approach can improve early access to and relevance of care during pregnancy and parenting for Aboriginal people.

Résumé

Objectif

Décrire la façon dont les intervenants communautaires perçoivent l’importance de soins sûrs et adaptés pour « faire une différence » sur les plans de la santé et du bien être des femmes enceintes et des parents autochtones. Parmi les intervenants communautaires, on compte des membres des communautés, des fournisseurs de soins de santé et de services sociaux, ainsi que des responsables communautaires et sanitaires.

Méthodologie

Une perspective postcoloniale, des principes de recherche participative et une étude de cas ont été employés pour examiner deux expériences d’organismes autochtones pour améliorer les soins prodigués aux femmes enceintes et aux parents autochtones. Les données ont été recueillies à partir des notes des chercheurs travaillant sur le terrain, d’entrevues exploratoires et de discussions en petits groupes avec des fournisseurs ainsi que des responsables et des membres de la communauté, tous choisis à dessein. Les données ont été analysées à l’aide d’une méthode descriptive d’interprétation de données.

Résultats

Les perceptions des intervenants communautaires sur l’importance de soins sûrs et adaptés pour « faire une différence » qui ressortent sont: la reconnaissance de résultats pertinents en matière de soins, la reconnaissance de progrès graduels et l’utilisation d’une démarche axée sur les forces, laquelle permet aux fournisseurs d’apprécier les efforts déployés par les personnes et les défis posés par leur situation contextuelle particulière.

Discussion

« Faire une différence » sur les plans de la santé et du bien-être des femmes enceintes et des parents autochtones pourrait faciliter le travail entrepris par les peuples autochtones pour s’attaquer aux déterminants sociohistoriques, profondément ancrés, du bien-être et de la capacité et, par conséquent, entraîner un changement de priorités en matière de soins en amont afin de se concentrer sur ces déterminants. Un tel paradigme de soins intégrerait plusieurs perspectives quant aux résultats souhaitables à l’intérieur de cadres locaux, en fonction des valeurs et des priorités des parents autochtones, tout en intégrant les avantages et la sagesse d’approches existantes en aval en matière de soins.

Conclusion

La conception et l’évaluation de soins fondées sur les valeurs et les priorités communautaires et faisant appel à une démarche axée sur les forces peuvent favoriser l’accès rapide aux soins et la pertinence de ceux-ci pour les femmes enceintes et les parents autochtones.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. de Costa C, Child A. Pregnancy outcomes in urban Aboriginal women. Med J Australia 1996;164(9):523–26.

    PubMed  Google Scholar 

  2. Goldman N, Glei D. Evaluation of midwifery care: Results from a survey in rural Guatemala. Soc Sci Med 2003;56:685–700.

    Article  PubMed  Google Scholar 

  3. Hoyert D, Freedman M, Strobino D, Guyer B. Annual summary of vital statistics: 2000. Pediatrics 2001;108(6):1241–55.

    Article  CAS  PubMed  Google Scholar 

  4. Humphrey M, Holzheimer D. A prospective study of gestation and birthweight in Aboriginal pregnancies in far north Queensland. Austr N Z J Obstet Gynaecol 2000;40(3):326–30.

    Article  CAS  Google Scholar 

  5. Luo Z, Kierans W, Wilkins R, Liston R, Uh S, Kramer M. Infant mortality among First Nations versus non-First Nations in British Columbia: Temporal trends in rural versus urban areas, 1981–2000. Int J Epidemiol 2004;33:1252–59.

    Article  PubMed  Google Scholar 

  6. Affonso D, Mayberry L, Inaba A, Matsuno R, Robinson E. Hawaiian-style “Talkstory”: Psychosocial assessment and intervention during and after pregnancy. J Obstet Gynecol Neonatal Nurs 1996;25:737–42.

    Article  CAS  PubMed  Google Scholar 

  7. Martens P. Increasing breastfeeding initiation and duration at a community level: An evaluation of Sagkeeng First Nation’s community health nurse and peer counsellor programs. J Human Lactation 2002;18(3):236–46.

    Article  Google Scholar 

  8. Bucharski D, Brockman L, Lambert D. Developing culturally appropriate prenatal care models for Aboriginal women. Can J Human Sexuality 1999;34(1):151–54.

    Google Scholar 

  9. Fisher P, Ball T. The Indian Family Wellness project: An application of the tribal participatory research model. Prev Sci 2002;3(3):235–40.

    Article  PubMed  Google Scholar 

  10. Polashek N. Cultural safety: A new concept in nursing people with different ethnicities. J Adv Nurs 1998;27:452–57.

    Article  Google Scholar 

  11. Smye V, Browne A. ‘Cultural safety’ and the analysis of health policy affecting Aboriginal people. Nurse Researcher 2002;9(3):42–51.

    Article  PubMed  Google Scholar 

  12. Browne AJ. Discourses influencing nurses’ perceptions of First Nations patients. Can J Nurs Res 2005;37(4):62–87.

    PubMed  Google Scholar 

  13. Smith D, Varcoe C, Edwards N. Turning around the intergenerational impact of residential schools on Aboriginal people: Implications for health policy and practice. Can J Nurs Res 2005;37(4):38–60.

    PubMed  Google Scholar 

  14. Smith D, Edwards N, Varcoe C, Martens P, Davies B. Bringing safety and responsiveness into the foreground of care for pregnant and parenting Aboriginal people. Adv Nurs Sci 2006;29(2):E27–E44.

    Article  Google Scholar 

  15. Fletcher C. Community-based participatory research relationships with Aboriginal communities in Canada: An overview of context and process. Pimatziwin 2002;1(1):29–61.

    Google Scholar 

  16. Macaulay A, Delormier T, McComber A, Cross E, Potvin L, Paradis G, et al. Participatory research with native community of Kahnawake creates innovative Code of Research Ethics. Can J Public Health 1998;89(2):105–8.

    CAS  PubMed  Google Scholar 

  17. Battiste M (Ed.). Reclaiming Indigenous Voice and Vision. Vancouver, BC: UBC Press, 2000.

    Google Scholar 

  18. Reimer-Kirkham S, Anderson J. Postcolonial nursing scholarship: From epistemology to method. Adv Nurs Sci 2002;25(1):1–17.

    Article  Google Scholar 

  19. Browne AJ, Smye V, Varcoe C. The relevance of postcolonial theoretical perspectives to research in Aboriginal health. Can J Nurs Res 2005;37(4):17–38.

    Google Scholar 

  20. Yin R. Case Study Research-Design and Methods, 2nd ed. London, UK: Sage Publications, 2003.

    Google Scholar 

  21. Abelson J. Understanding the role of contextual influences on local health-care decision making: Case study results from Ontario, Canada. Soc Sci Med 2001;53:777–93.

    Article  CAS  PubMed  Google Scholar 

  22. Dopson S. The potential of the case study method for organizational analysis. The Policy Press 2003;31(2):217–26.

    Google Scholar 

  23. Thorne S, Reimer-Kirkham S, Flynn-Magee K. The analytic challenge in interpretive description. Int J Qual Methods 2004;3(1):Article 1. Available online at: https://doi.org/www.ualberta.ca/~iiqm/ backissues/3_1/html/thorneetal.html (Accessed March 2, 2006).

    Google Scholar 

  24. Fetterman D, Kaftarian S, Wandersman A (Eds.). Empowerment Evaluation: Knowledge and Tools for Self-Assessment and Accountability. Thousand Oaks, CA: Sage, 1996.

    Google Scholar 

  25. Prilleltensky I. Promoting well-being: Time for a paradigm shift in health and human services. Scand J Public Health 2005;33(Suppl 66):53–60.

    Article  Google Scholar 

  26. Lindsey EW. Social work with homeless mothers: A strength-based solution-focused model. J Fam Soc Work 2000;4(1):59-78.

    Article  Google Scholar 

  27. Hooser D. Public health nurses used 4 strategies to facilitate client empowerment. Evid Based Nurs 2002;5(3):94.

    Article  PubMed  Google Scholar 

  28. Brough M, Bond C, Hunt J. Strong in the City: Towards a strength-based approach in Indigenous health promotion. Health Promot J Aust 2004;15(3):215–20.

    Article  Google Scholar 

  29. Bartlett JG. Health and well-being for Metis women in Manitoba. Can J Public Health 2005;96(Suppl. 1):S22–S27.

    PubMed  Google Scholar 

  30. Chino M, DeBruyn L. Building true capacity: Indigenous models for indigenous communities. Am J Public Health 2006;96:596.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Fetterman D, Wandersman A (Eds.). Empowerment Evaluation Principles in Practice. New York, NY: Guilford Press, 2005.

    Google Scholar 

  32. Patton M. Utilization Focused Evaluation, 2nd ed. Beverly Hills, CA: Sage Publications, 1986.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Nursing, University of Ottawa, Room 3251b-451 Smyth Rd, Ottawa, ON, Canada, K1H 8M5

    Dawn A. Smith RN, PhD (Assistant Professor)

  2. School of Nursing and Department of Epidemiology and Community Medicine, University of Ottawa, Canada

    Nancy C. Edwards RN, PhD (Professor)

  3. Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada

    Patricia J. Martens PhD (Director, Manitoba Centre for Health Policy and Associate Professor)

  4. School of Nursing, University of British Columbia, Vancouver, BC, Canada

    Colleen Varcoe RN, PhD (Associate Professor)

Authors
  1. Dawn A. Smith RN, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nancy C. Edwards RN, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patricia J. Martens PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Colleen Varcoe RN, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dawn A. Smith RN, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Smith, D.A., Edwards, N.C., Martens, P.J. et al. ‘Making a Difference’: A New Care Paradigm for Pregnant and Parenting Aboriginal People. Can J Public Health 98, 321–325 (2007). https://doi.org/10.1007/BF03405411

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03405411

MeSH terms

Search

Navigation