Searching for Evidence: What works in Indigenous Mental Health ...

QUT Digital Repository: http://eprints.qut.edu.au/

Clelland, Nicole A. and Gould, Patricia M. and Parker, Elizabeth A. (2007) Searching for Evidence: What works in Indigenous Mental Health Promotion?. Health Promotion Journal of Australia 18(3):pp. 208-216.

© Copyright 2007 Australian Health Promotion Association

Indigenous mental health Review

Searching for Evidence: What works in Indigenous Mental Health Promotion?

Nikki Clelland1 Trish Gould2 Elizabeth Parker2

Correspondence: Nikki Clelland Menzies School of Health Research PO Box Ph: 08 8922 7646 Fax: 08 8927 5187 Email: [email protected] 1

Menzies School of Health Research, Northern Territory

2

School of Public Health, Queensland University of Technology


ABSTRACT

Issue addressed: The high rates of mental health issues confronting Indigenous populations makes it imperative that action to promote mental health and prevent the development of mental health problems in these populations is effective. An accumulating evidence base for mental health promotion now exists; however, it remains significantly underdeveloped for Indigenous groups. Methods: This paper outlines the key findings of a systematic review of the literature undertaken to identify attributes of effective Indigenous mental health promotion interventions. Results: Conclusive evidence of the efficacy of Indigenous mental health promotion interventions could not be determined, because the current evidence base is limited. However, this review did highlight a number of important findings. Firstly, there were few well conducted intervention evaluations; in many, the design was weak and insufficient information was supplied to assess effectiveness. Secondly, Indigenous mental health promotion initiatives commonly focused on individual behaviour change, rather than the broader social, ecological or policy determinants. Thirdly, many interventions involved extensive Indigenous participation, thus supporting cultural relevance and community involvement, essential for the future of Indigenous mental health promotion. Conclusions: There is insufficient evidence regarding effective mental health promotion and prevention interventions for Indigenous populations. Key words: effectiveness; evidence; health promotion; Indigenous; mental health

SO WHAT? This paper will assist policy makers, practitioners and researchers to plan more effective mental health promotion interventions for Indigenous people. Future developments should ensure meaningful Indigenous participation, and focus on the implementation and evaluation of comprehensive interventions, together with appropriate dissemination of findings.


INTRODUCTION

The need for effective action to promote mental health and prevent the development of mental health problems is undisputed, particularly for Indigenous populations, who are acknowledged as having the highest rates of illness, creating considerable disparities between Indigenous and non-Indigenous populations.1,2

The nature and extent of mental health problems amongst Indigenous Australians is difficult to quantify. Few epidemiological studies on Indigenous mental health have been undertaken and the existing data on Indigenous mental health is inadequate.3 However, the latest report on the health and welfare of Australia’s Indigenous peoples indicates, that when compared to the general population, Indigenous Australians:

•

Have more hospital separations for most types of mental and behavioural disorders, particularly those due to psychoactive substance use;

•

Are more likely to be hospitalised as a result of assault and intentional self harm;

•

Are more likely to die as a result of assault or suicide; and

•

Have higher incarceration rates, particularly among young people aged 1017 years.2


There is increasing evidence to support the role of mental health determinants in substance misuse, child abuse, family and domestic violence, and criminal behaviour. Many researchers have described pathways to these adverse outcomes, emphasising the commonalities in their determinants and the importance of intervening earlier in their development. 1,4-7 While no causal relationship can be assumed, it is important to consider the role risk and protective factors play in these developmental pathways, as this will provide a crucial first step in formulating effective interventions for a range of psychosocial problems, including mental health problems. Research into the determinants of mental health has identified poverty, social disadvantage, violence, family conflict, abuse, substance abuse and life stress as factors that increase the likelihood of developing mental health problems. Indigenous Australians experience higher rates for each of these factors reflecting, and contributing to, the poor state of Indigenous mental health. This situation is exacerbated by the failure to acknowledge and address the impact of colonisation and the destruction of Indigenous culture.3,8

Despite such adversity, Indigenous peoples have shown resiliency; which derives from relationships with the extended family and ties to culture, community and country.1 While comparatively little research has been conducted on the relationship between mental health and protective factors, the available evidence suggests that opportunities for success, recognition of achievement and economic


security are all protective of mental health. This is the case for both mainstream and Indigenous populations groups.1,9

For Indigenous Australians, health is a holistic concept and mental health is entwined with physical, social, emotional and spiritual health1. For the purposes of this report, the following Indigenous definition of health is used:

[Health is] Not just the physical well-being of the individual, but refers to the social, emotional, spiritual and cultural well-being of the whole community. This is a whole of life view and includes the cyclical concept of life-deathlife.10

There has been an increase in enthusiasm for undertaking reviews of effectiveness in different areas of health promotion.11 Over the last decade, there have been numerous reviews of the evidence for programs targeting mental health promotion and the prevention of mental disorders.12-19 None, however, are specific to Indigenous populations. This report reviews a select number of Indigenous mental health promotion interventions with the aim of informing decisions about practice, policy and research needs, as well as advancing the evidence base in this critical area.

METHOD


Together with an Indigenous-specific database, the Aboriginal and Torres Strait Islander Health Bibliography, the following electronic bibliographic databases were selected, based on their focus and use in previous mental health promotion effectiveness reviews:12,14,20

•

Medline;

•

PsycINFO; and

•

CINAHL.

A model depicting five categories of health promotion interventions (see Figure 1) was used as a guide to describe the mental health promotion interventions in the selected studies.21

Figure 1 HERE

Search Criteria Only evaluated interventions that were relevant to the mental health of Indigenous Australians22 were considered for this review, these interventions include those intended to promote the following outcomes: · Increased mental health, quality of life and resilience · Increased mental health literacy


· Improved family functioning and parenting skills · Enhanced social support and community connectedness · Reduction of racism, discrimination and oppression Due to the relatively comprehensive work in the area7, studies that focused on substance misuse, including alcohol and other drugs, were excluded from this analysis process.

In addition to interventions specifically for Indigenous population groups (as defined by database thesauri); also considered were those aimed at population groups with similar experiences and/or health status to that of Indigenous peoples, or mainstream population groups that included Indigenous participants. Studies also had to fulfil the following criteria: •

Published between January 1990 and October 2003.

•

Available from Australian libraries and information services within four weeks of ordering.

While the debate often centres on the differences between health promotion and disease prevention in terms of their focus (that is, on positive health and wellbeing or disorder and disease respectively) they are inextricably linked strategies. Mental health promotion often refers to both the prevention of mental health problems and the promotion of psychological wellbeing. A number of mental health promotion frameworks reflect this overlap.9,23


A scan of the titles was conducted and records were excluded on the basis of duplication and irrelevance. Abstracts were then reviewed using the criteria outlined above. Copies were obtained where the abstract indicated that the study either fulfilled the criteria or offered valuable background material.

There was wide variability in the types of interventions, implementation settings, target populations and evaluation methods described in the studies (Table 1). From a scan of the literature, and of previous effectiveness reviews, a variety of critical appraisal tools were identified.12,14,24

Table 1 HERE

An abbreviated version of Rychetnik and Frommer’s24 framework was developed and used to appraise the identified studies (Table 2).

Table 2 HERE

RESULTS

Only 22 of the 1144 articles identified fulfilled the criteria. The number and proportion of studies according to life stage is outlined in Figure 2.


Figure 2 HERE

Studies were grouped according to the main outcome targeted; that is, whether they focused on promoting positive aspects of mental health (n=11) or the prevention or reduction of specific problems (n=11).

In the first group, six studies focused on family functioning and parenting.25-30 Of the five studies focusing on promoting positive aspects of mental health, the interventions were designed to empower Indigenous people,31,32 promote wellness through traditional practices,33 improve cognitive thinking skills34 or provide social support.35 No studies addressing mental health literacy were identified.

In the second group, five studies addressed reducing the impact of grief, loss, trauma or violence.36-40 All of the studies grouped according to reducing mental health problems (n=4) focused on the prevention of suicide.41-44 Two studies focused on reducing racism through educating non-Indigenous groups.45,46

Given this review’s emphasis on the evidence of effectiveness, it was important to assess the studies based on the methodological quality of the evaluation design. Studies were categorised according to the National Health and Medical Research Council’s hierarchy of study design.47 There were no studies utilising randomised controlled designs. The majority of studies were considered relatively low in strength, using either post-test or pre-test/post test designs (n=11), or comparative


or interrupted time series studies with (n=4), and without (n=4), control groups. Three studies could not be categorised, as they had not provided sufficiently detailed descriptions.

Evaluation rigour varied greatly within and across the grouped study designs. Few reports described precise aims, sample size or justification for variance in attrition rates. A number of studies did not note baseline or pre-test results, thereby limiting the strength of the conclusions drawn from the post test evaluations. Some studies also reported evaluation outcomes that differed from intervention goals.

Evaluations were conducted immediately after the intervention in four studies. Most follow-up evaluations were undertaken within two months (n=4); however, one study measured outcomes at three months,45 one at six months28 and one at both eight and twelve months.26 Two papers reported results of an action research process25,32 and one study was conducted retrospectively.44 In five studies, the timing of the evaluation in relation to the implementation was not specified.27,29,31,38,39

Six interventions were conducted in community settings25,31,32,37,38,43 and six in a combination of sites,27,29,30,35,42,44 reflecting the health education approach and the multi-strategic nature of intervention studies. Four studies were delivered in educational settings;34,36,41,46 these included school-based violence prevention36 and suicide prevention programs.41 Two were implemented in the home,26,28 two in


correctional facilities,39,40 one in a workplace45 and one in a health centre.33 These included home visiting programs,26,28 a cross cultural training workshop45 and life skills training for prison inmates.39

Examining contextual factors in the development and implementation of interventions

can

provide

insight

into

possible

reasons

for

intervention

effectiveness (or otherwise), and the applicability of the intervention to other settings.

The rationale for the development of mental health promotion

interventions can be based on different dimensions of ‘need’.

These can be

considered ‘normative’ (determined by expert opinions), ‘expressed’ (determined by service utilisation), ‘comparative’ (determined by examining services provided to one population and inferring need in another) or ‘felt’ (determined by the community).48 Eight interventions in this review were developed in response to normative need25,35,37-39,42,44,45 and seven to felt need.27,29,31-33,41,43

Six were

developed in response to comparative need,26,28,30,34,36,40 all except one of these were interventions adapted from mainstream population groups.40

While the studies were grouped according to the primary reason for their development, some utilised more than one method of determining intervention need. For example, community need and empirical evidence were used to develop a culturally appropriate suicide prevention program for Zuni youth (American Indians).41 Almost all the studies used research evidence to guide intervention development or determine strategy selection. A number of intervention strategies


were based on traditional cultural practices, for example, two interventions utilised story-telling to disseminate health information,29,33 while another held smoking ceremonies and traditional feasts to engage local community members.27 Table 3 illustrates the variety of people involved in intervention development.

Some

interventions had more than one developer; bringing the total to thirty-six.

Table 3 HERE

One quarter (n=9) of the interventions were developed by the evaluators or study authors. Ten were either developed by Indigenous people, or had Indigenous input. For example, the Family Wellbeing Course was developed by Indigenous people; 31 while the Perinatal Intervention involved collaboration between Indigenous and non-Indigenous staff and the local community.27

There were significantly more Indigenous (n=15) than non-Indigenous providers (n=9); five studies did not specify the providers.30,39,42-44 The largest categories of providers were Indigenous community workers (n=6) and non-Indigenous health professionals (n=6).

The interventions delivered by Indigenous community workers27-29,31,38,40 and Indigenous volunteers25,32,33,35,41 were more likely to feature appropriate cultural practices, and therefore, receive community support. In the classroom setting, interventions were delivered by non-Indigenous teachers34 or by non-Indigenous


teachers working with Indigenous aides.41 Two interventions were delivered by the intervention developers37,46 and one intervention was delivered by Indigenous providers to their non-Indigenous co-workers.45 Five intervention studies used one intervention type alone (health education and/or skill development), while six implemented four or more intervention types. This may account for some of the variation in effectiveness.

DISCUSSION

A significant finding of this review is that the evidence base for the effectiveness of Indigenous mental health promotion is underdeveloped. This does not suggest that mental health promotion is ineffective for Indigenous populations. For services involved in mental health promotion policy and practice for Indigenous populations, this presents significant challenges.

This review has highlighted the lack of rigorous intervention evaluations for mental health promotion in Indigenous populations. While it is not expected that evaluation designs be restricted to randomised controlled trials, there is a need to embrace robust evaluation methodologies that measure and document intervention processes as well as outcomes.

To adequately measure the long-term impact of interventions on Indigenous mental health, appropriate and reliable sources of epidemiological information are


required. This data needs to extend beyond the traditional realms of problems, to indicators of wellbeing.

Adopting an evidence based approach also requires feedback and reflection. There is currently a strong cultural, geographic and researcher/academic bias in the way ‘evidence’ is articulated and represented in the published literature.49 Much of the ‘evidence’ for Indigenous mental health promotion remains unpublished. The challenge is to find creative ways of uncovering and documenting innovative forms of policy and practice. One way is for policy makers and practitioners to work in partnership with researchers and Indigenous health professionals.

This review underlines the limited attempts to implement and evaluate multistrategic interventions. The included studies had a predominantly individual focus, with limited strategies addressing the broader society/community and public policy. Merzel and D’Afflitti50 suggest that effective strategies for community-based health promotion may involve a three-tiered approach: one-on-one interventions for high risk individuals, community wide interventions to change social norms, and policy level efforts to modify social and political environments. Furthermore, this review has highlighted the value of Indigenous input from health professionals and community members for effective strategy development and implementation.


In an environment of limited resources, the effectiveness of health promotion is constantly questioned. Synthesising what is known about what works, how and why is crucial for decisions on resource allocation for health promotion; consequently, there has been increased enthusiasm for undertaking reviews of effectiveness. The challenge is ensuring the workforce is adequately skilled and resourced to do so.

Study Limitations Defining what was considered a mental health outcome or a mental health promotion intervention proved problematic for the methodology in two ways. Firstly, individual bibliographic database vocabularies define the identified terms differently. For example, ‘mental health’ was often referred to mental ill health and not wellbeing or wellness. This made it difficult to retrieve information relevant to the review and is particularly important given Indigenous definitions of health. Secondly, given the range of terms that could be used to describe for example, mental health or health promotion, the sensitivity of the search strategies was reduced. A study on health promotion systematic reviews by Peersman et al.11 found that less sensitive searches (which identify a lower number of relevant studies) reduced the possibility of reviewers being able to detect clear patterns for effective and ineffective interventions. This may help explain the results of this review.


There were issues with appraising published studies with predetermined criteria; most citations were not written with an expectation of being reviewed in this way; therefore, it was difficult to extract relevant information. For example, information on how the intervention had been developed and/or details of the evaluation methods did not make it into some reports; and these are required to determine effectiveness.

This is problematic when conclusions about effectiveness are

offered and little detail is provided about the processes.

To be included in this review, the reported intervention must have been evaluated; however, the method or evaluation design used was not restricted. This was because of the inherent difficulties in evaluating complex community based interventions, and to ensure a more inclusive approach for a wider range of evidence than is traditionally considered. This decision, however, also posed a series of challenges for this review because the level of evaluation detail provided in the intervention studies varied greatly.

CONCLUSION

Given the scarcity of the published literature on effective mental health promotion interventions for Indigenous populations, it is problematic to draw conclusions as to the efficacy of such interventions.


There is a paucity of well conducted intervention evaluations. While the results of a few interventions showed some preliminary effects, it was unclear whether there were any longer-term, sustainable benefits. It is recommended that appropriate evaluation methods be identified, or developed, and implemented.

The review highlighted the lack of research addressing the broader social, ecological and policy determinants of Indigenous mental health; the majority of interventions are directed at individual behaviour. An emphasis should be placed on efforts that modify the broader structural and policy level environments.

It was encouraging to find that many of the interventions were developed and implemented by Indigenous people or involved Indigenous participation at all levels of decision making. This is a significant factor for ensuring cultural relevance and community involvement in Indigenous mental health promotion interventions.51

These findings highlight a number of important issues that will assist policy makers, practitioners and researchers plan more effective Indigenous mental health promotion interventions.

Firstly, ongoing Indigenous participation and engagement will ensure the cultural relevance, need and appropriateness of interventions and directly & indirectly develop Indigenous capacity; as has been highlighted in National Aboriginal and Torres Strait Islander policy, strategic and research plans.


Secondly, when developing mental health promotion interventions consideration should be given to ensuring multiple strategies addressing more than just individual behaviour change are developed, implemented and evaluated; these should target factors along the developmental pathways of mental health problems and the range of related psychosocial outcomes.

Thirdly, this review has highlighted that future research can explore the identification and/or development of appropriate indicators and evaluation methodologies for mental health. Additionally, researchers need to find creative ways of disseminating findings of Indigenous mental health promotion interventions to improve the adoption and uptake of evidence-based practice. Dissemination strategies should target a range of audiences, for example, papers in peer reviewed journals, Indigenous specific communication resources (eg. newsletters, HealthInfonet, Aboriginal and Torres Strait Islander Health Worker Journal), oral presentations to community groups and brief summaries outlining the ‘bottom line’ for policy makers.

Finally, policy makers can utilise these results as potential contributors of promising programs/interventions to inform funding decisions for Indigenous mental health promotion.

ACKNOWLEDGMENTS


The Northern Territory Department of Health and Community Services (DHCS) commissioned the Cooperative Research Centre for Aboriginal Health (CRCAH) to undertake this review. It was made possible through funding from the Australian Network for Promotion, Prevention and Early Intervention for Mental Health (Auseinet).

Ms Vanessa Harris, Cooperative Research Centre for Aboriginal Health, and Ms Lynette O’Donoghue, Northern Territory Department of Health and Community Services, have provided timely and constructive comments from an Indigenous perspective to the authors during the research process and our writing of this paper. We would like to thank them for their continued support.

NC’s work on this research was conducted as a NT Department of Health and Community Services employee on part time secondment to the Cooperative Research Centre for Aboriginal Health.


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Table 1 Included Studies Study & Target Group/s

Goal, Intervention and Evaluation

Brave Heart (1998) Lakota people (Native American)

Goal: Effectiveness of a psycho-education group intervention aimed at facilitating grief and trauma resolution. Intervention: psycho educational curriculum intervention. 4 days. Measures: Pre: Demographic and trauma history

Brave Heart, MYH (1999) Lakota parents

Goal: to increase parental awareness of generational trauma and promote reconnection with traditional values Intervention: Parenting skills curriculum; 7 sessions Measures: Awareness of historical trauma impact on parenting; Behaviour and attitudes to parenting; Awareness of traditional culture

Capp et al (2001) Indigenous community members and workers

Goal: reduce youth suicide through increased ability to recognise suicide risk and facilitate appropriate professional referral / help seeking Intervention: Workshops- Community gatekeeper training Measures: Attitudes, Knowledge, Confidence, Help seeking intention, Intention to refer, Some process measures reported

Cooper et al (2002) Pregnant indigent mothers

Goal: provide emotional support and encourage sensitive responsive interactions with infant. Intervention: Home visit – 1 hour sessions Measures: Maternal views of help received; Maternal mood, Anthropometric measures of infant, Mother-infant interaction

Davis & Prater (2001) American Indian infants

DeBruyn, May & Sitaker (1998) North American Indian adolescents, aged 15–19

Goal: monitor the development of American Indian infants (0-12 months); increase numbers of American Indian women who enter prenatal care early in pregnancy; and ensure continuity care Intervention: multiple strategies Measures: Birthweight, infant mortality, maternal diet, alcohol and tobacco use Goal: not clear Intervention: Broad suicide prevention program: Measures: Rates of suicide attempts/Completions pre & post

DuRant et al (1996) Middle school students (majority African American)

Goal: to compare the effectiveness of violence prevention curricula Intervention: 1. Conflict resolution curriculum, 2. violence prevention curriculum, both class-room format Measures: Hypothetical use of violence, Violence avoidance, Previous use of violence, Frequency of fights resulting in significant injury

Fisher & Ball (2002), American Indian; Alaska Native Pre-school aged children and their parents

Goal: develop culturally grounded family centred preventive intervention Intervention: multiple family centred prevention interventions: storytelling], paraprofessional home visits Measures: Participation in cultural activities; Community connectedness; Storytelling; Service utilisation, Parental psychosocial adjustment

Flynn (1999) High risk pregnant adolescents (majority African American)

Goal: improve health outcomes through enhancement of health practices and parenting skills Intervention: home visit to provide social support & education regarding child development and health behaviours Measures: Infant birth weight, Immunisation, Post/neonatal mortality, Repeat pregnancy, Referrals to child protective services, Child abuse risk

Forti & Koerber (2002) Older African Americans

Goal: improve access to and utilisation of health care and social services to enhance quality of life of older African Americans. Intervention: Home visits, health education, service advocacy by outreach workers for 3 rural communities (case management model) Measures: Depression, Independent and basic activities for daily living

Hill & Augoustinos (2001) Non-Indigenous staff

Goal: reduce prejudice towards Aboriginal Australians Intervention: 3 day cross cultural training workshop for staff Measures: Changes in knowledge, attitudes and stereotyping


Study & Target Group/s

Goal, Intervention and Evaluation

Hodge et al (2002) American Indians

Goal: to promote alteration of lifestyle, motivate adoption of traditional healthy lifestyles and practices Intervention: storytelling to promote health and wellness Measures: None specified

Kumpfer et al (2002) Children of substance abusers

Goal: compares effectiveness of culturally adapting family interventions in improving retention and intervention outcomes to generic versions. Intervention: multicomponent, 14 session family skills training Measures: Recruitment and retention

LaFromboise et al (1995) 14 – 19 year old Zuni Indians

Goal: Evaluate effectiveness of a suicide prevention program in reducing factors identified as correlates of suicidal behaviour. Intervention: School based life skills curriculum. Measures: Vulnerability, Hopelessness, Depression, Self efficacy, Problem-solving skills

Mardiros (2001) Aboriginal Australians

Goal: To describe community based action research process to empower Indigenous communities Intervention: Community based action research process to identify strategies including ‘grog patrol’ Measures: Monitoring and documenting community and small group meetings. Observations and field notes categorised into themes.

McFarlane & Fehir (1994) Hispanic females

Goal: Decrease barriers and increase access to prenatal care Intervention: information provision Measures: How is the program going? How could the program be improved?

Place et al (2000) Native Canadian prison inmates

Goal: compare recidivism rates of intensive pre-release support vs no intervention Intervention: 11 week life skills training including Measures: Recidivism rates

Ritchie & Edwards (1996) 11 – 12 year old Aboriginal Australian children

Goal: the effects of a general thinking skills program. Intervention: mainstream cognitive thinking skills workshop 20 lessons, classroom setting Measures: Creativity, Fluency, Flexibility & originality, Scholastic aptitude, Cognitive skills application, Self-concept as a thinker, Locus of control Goal: To assess the effectiveness of diversity training exercise on college students stereotyping and prejudice. Intervention: Jane Elliott’s “Blue-Eyes/Brown-Eyes” diversity Training 1 day (including verbal abuse, videos, discussion sessions) Measures: Degree of prejudice

Stewart et al (2003) First year college students Tsey & Every (2000a) Aboriginal Australian families

Goal: To evaluate the effectiveness of a family wellbeing empowerment course. Intervention: workshop placing particular emphasis on parenting and relationship skills. 10 sessions – 1 x 4 hour session/week Measures: Theoretical validity of course, Nature and process of empowerment, Strategies for sustainability

Zaloshnja et al (2003) Native American 15-19 year olds

Goal: to analyse the cost efficacy of five injury prevention projects. Intervention: multicomponent suicide prevention program Measures: Cost savings (medical, work loss and quality of life)

Zellerer (2003) Canadian Aboriginal male prison inmates

Goal: Describes a family violence program for inmates Intervention: group workshop 29 sessions, 2.5 hours over 4 months Measures: Participant and prison staff perspectives of the program


Table 2. Individual article data extraction and interpretation No.

Assessment Criteria

1

What type of intervention is reported?

2

What was the aim/goal of the intervention?

3

Who was the provider of the intervention?

4

Who were the stakeholders?

5

What aspects of the context in which the intervention took place are identified? Eg. skills of provider, social or cultural factors, policy environment, resourcing.

6

Was the intervention or selection of strategies based on theory or research?

7

Was the intervention evaluated?

8

What research methods were used to evaluate? Eg. quantitative or qualitative or both

9

What was the timing of the intervention evaluation in relation to the implementation?

10

What study designs were used in the evaluation? I

Systematic review of all relevant RCT

II

Properly designed RCT

III-1

Well-designed pseudo-RCT (eg. alternate allocation)

III-2

Comparative studies (or systematic reviews of such studies) with

concurrent controls and allocation not randomised, cohort studies, casecontrol studies, or interrupted time series with control group III-3

Comparative studies with a historical control, two or more single arm

studies, or interrupted time series without parallel control group IV

Case series, post-test or pre-test/post test with no control group

11

How rigorous was the evaluation? Eg. sample size

12

What measures of effect or intervention outcomes were examined?

13

What findings were reported?

14

Were the intervention outcomes sustainable?

15

Is the intervention reproducible or applicable in an Australian Indigenous context?


Table 3. Persons involved in intervention development (n=36) Persons involved in intervention development

N

%

Indigenous population groups

10

28

Intervention Evaluator or Study author

9

25

Intervention Provider/s

8

22

Other eg. adapted version of intervention developed elsewhere

7

19

Not specified / unclear

2

6


Individual Screening, individual risk assessment, immunisation

Population

Health education and skill development

Social marketing

Community Action

Settings and supportive environments

Health information

Ensuring the capacity to deliver quality programs through capacity building strategies including: Workforce development

Organisation Development

Resources

Figure 1: Categories of Health Promotion Interventions21 (p. 44)


Perinatal (n=7; 32%)

Older (n=1; 5%)

Child & Youth (n=6; 27%)

Adults (n=8; 36%)

Figure 2: Number and proportion of studies according to age range (N=22)