Kalyakool Moort - Always Family: Strong culture, strong care, strong families: Codesigning a culturally considered approach to perinatal screening and support for the first 1000 days of parenthood from conception to infancy

Kotz, Jayne (2021) Kalyakool Moort - Always Family: Strong culture, strong care, strong families: Codesigning a culturally considered approach to perinatal screening and support for the first 1000 days of parenthood from conception to infancy. PhD thesis, Murdoch University.

Abstract

Background: Indigenous maternal and child health and wellbeing outcomes remain unacceptably poor and is reflected in low participation in Edinburgh Postnatal Depression Scale (EPDS) screening. Evidence shows that early exposure to maternal anxiety and depression is a strong predictor of maternal, infant, child and adolescent health and wellbeing outcomes. Critical consideration should also be given to whether current screening is culturally safe, effective and responsive and/or further colonising.

Assessing mental health needs is critical for prevention and care during the critical 1000 days from conception to the early years of parenthood. Psychometric properties of mental health screens are important. However, critical consideration should also be given to whether current screening is culturally safe, effective and responsive.

Aim: This program of work investigated the barriers to successful perinatal screening for Aboriginal Mothers and developed a culturally secure evidence-base to support the formulation of a new gold standard for perinatal care for Aboriginal Australians.

Methodology: A decolonising approach using community participatory action research (CPAR) methods was operationally centred around guidance from an Aboriginal leadership and governance collective. It was a shared view of all groups in this collective that the EPDS has significant limitations in an Australian Aboriginal context, and that there was an urgent need to find culturally stronger ways of supporting families during the perinatal period. This consensus provided the starting point for this program of translational research. Noongar Elders gifted the name, Kalyakool Moort, meaning Always Family in Nyoongar language. The Kalyakool Moort project explored the a) current context of assessing the mental health and wellbeing of Aboriginal and Torres Strait Islander parents in the perinatal period, and b) enablers and barriers to strong parenting practices.

Two systematic literature reviews were undertaken. The first explored use of the EPDS with Aboriginal women. No evidence was found that the EPDS is suitable for screening Aboriginal women, nor that its adapted versions were widely applicable. The second, a psychometric review of Aboriginal symptom and risk measures found some progress toward culturally relevant mental health screening measures. This review was complemented by a cultural review of each measure undertaken by members of the Aboriginal leadership and governance collective. However, no single tool was found that had generalised transferability to Aboriginal women perinatally.

With the need for a new approach to perinatal mental health screening established, a mixed methods approach was adopted to gather data from experts with lived experience. Aboriginal parents and health professionals provided rich qualitative data through semi-structured interviews, ‘yarn’ sessions and focus groups. Quantitative data were derived from an anonymous practitioner questionnaire, two systematic literature reviews, and analysis of current screening tools. Initially drawing on a grounded theory, thematic analysis and Nvivo-12 were ultimately used for coding qualitative data. Findings from complementary data sources were triangulated, compared and contrasted through a cultural lens eliciting points of difference and congruence. Emergent data were used to prepare an evidence-base to inform a new gold standard in clinical perinatal practice, including providing impetus for the development of a new screening tool.

Results: Aboriginal parents frequently feel marginalised and disempowered by perinatal assessments and care, yet no evidence supports the validity of using existing screening tools with this population – a new framework is needed. Developing a culturally valid screening process is predicated on utilising a culturally sound research methodology. The emerging evidence-base from this series of studies suggests that perinatal screening for Aboriginal parents should be Family-centred (rather than singularly Mother-centred), strengths-based (rather than pathology-based) and culturally sound (rather than based on Western models). An innovative approach to perinatal screening is a translational outcome and will be the subject of a series of studies over the coming year.

Keywords: Indigenous; First Nation; Aboriginal; Wellbeing; Decolonising; Perinatal; Mental Health; Screening; Antenatal

Item Type:	Thesis (PhD)
Murdoch Affiliation(s):	Ngangk Yira Research Centre for Aboriginal Health and Social Equity
United Nations SDGs:	Goal 3: Good Health and Well-Being
Supervisor(s):	Marriott, Rhonda, Reid, Corinne and Rebill, Tracy
URI:	http://researchrepository.murdoch.edu.au/id/eprint/63836

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