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Improving developmental monitoring practices of remote Australian Aboriginal health workers

D'Aprano, Anita L. (2013). Improving developmental monitoring practices of remote Australian Aboriginal health workers. PhD Thesis, Charles Darwin University.

Document type: Thesis
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Author D'Aprano, Anita L.
Title Improving developmental monitoring practices of remote Australian Aboriginal health workers
Institution Charles Darwin University
Publication Date 2013
Thesis Type PhD
Subjects 1117 - Public Health and Health Services
Abstract The importance of early childhood development (ECD) is undeniable and child health experts internationally recognise that developmental care is vital to improve long-term health and wellbeing outcomes. A key challenge to the provision of quality
developmental care in remote Australian Aboriginal communities has been the absence of culturally appropriate, structured developmental screening tools. Also, Aboriginal Health Workers (AHWs), recognised as key staff in this context, and a high proportion of other remote health practitioners, do not have adequate training in the area of ECD.

The TRAK study aimed to design, implement and evaluate a capacity building program in developmental practice for AHWs. This included: a) the cultural adaptation of the Ages and Stages Questionnaire (ASQ-3) for use in remote Aboriginal communities; b) the design and trialing of an ECD training program; and c) the implementation of the culturally adapted ASQ-3 into standard health service practice, in remote Aboriginal health services.

A case study evaluation framework was adopted, utilising mixed methods, including interviews, observations and medical record audits. Two case study sites in the Northern Territory were selected - one remote health centre in a coastal ‘Top End’ community and one in Central Australia. Purposive samples of AHWs, key community informants, and Aboriginal parents, from the two sites, as well as ECD experts were included in the study. All children under 5 years of age, resident in the study communities, were included in an audit of medical records to determine baseline developmental practice of remote health staff.

The study findings demonstrated that the cross cultural adaptation of the ASQ-3 developmental screening tool (the ASQ3-TRAK tool) was considered highly acceptable and relevant to parents, AHWs and ECD experts. The training needs analysis identified gaps in existing knowledge and practice, through self report, practice observation and the medical record audits. The customised training program was delivered successfully and valued by all participants with demonstrated improvements in practitioner skills, knowledge, competence and confidence to identify and manage developmental difficulties in young children and promote child development.

Despite the acceptability and value of the developmental screening tool and the ECD training, the integration of the adapted ASQ-3 into routine health service did not occur as intended. Challenges to the uptake and ongoing use of the adapted tool were identified in three broad themes: leadership and governance, workforce support, and health centre structures.

This study sought to advance understanding of some of the critical factors needed to build the capacity of AHWs and other remote health practitioners in providing quality developmental care to remote-dwelling Aboriginal children. The findings identified key barriers and potential solutions to improving developmental practice in this challenging service context. These include effective and culturally appropriate practitioner training in ECD, the availability of a culturally appropriate developmental screening tool, and service requirements for its routine use. These findings have implications for policy, practice and further research to improve the developmental outcomes of Australian Aboriginal children.

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