'Hey, We Are the Best Ones at Dealing with Our Own': Embedding a Culturally Competent Program for Maori and Pacific Island Children into a Mainstream Health Service in Queensland, Australia.

OBJECTIVE: We present the results of one component of an external evaluation of Good Start Program (GSP), a community-based program for the prevention of chronic disease among Maori and Pacific Island (MPI) communities living in the state of Queensland, Australia. DESIGN: An evaluation of the GSP was undertaken using a mixed methods approach. This paper reports on the qualitative component where interview and focus group data was collected, using Talanoa, a culturally tailored research methodology. Respondents included school students, community groups, teachers and parents, as well as the Good Start implementation team. RESULT(S): The five broad themes that emerged from this evaluation related to (i) components of cultural-competence and (ii) perceived impact of the program. The views of all participants reinforced the importance of culturally appropriate programs and highlighted how the multicultural health workers (MHWs) contributed to the program's perceived success. The challenges in understanding restrictions of the mainstream health service framework were noted indicating the need for it to be flexible in incorporating culturally appropriate components if a program was to be embraced. CONCLUSION: The qualitative evaluation of the GSP suggests that culturally tailored programs, delivered by MHWs, have the potential to impact positively on community-level behavioural changes that improve health. These findings, supported by studies from other countries, contribute to the evidence that cultural-tailoring of programs is critical for ensuring that culturally appropriate initiatives are embedded in health care systems that support multicultural communities. Embedding includes the development of culturally appropriate policies, a culturally competent workforce and long-term funding to support culturally competent initiatives.

Charting Availability of Processed and Unprocessed Foods in School Neighbourhood Nutrition Environments in an Urban Australian Setting.

School Neighbourhood Nutrition Environments (SNNEs) can facilitate or impede healthy eating. This study describes the SNNEs surrounding 6 Good Start Program (GSP) schools in 5 suburbs in Logan, Queensland. Relative density of healthy and unhealthy food outlets was calculated for SNNEs surrounding GSP (6) and non-GSP (10) schools within the 5 suburbs. Relative accessibility of minimally processed and highly processed food and drink in SNNEs of the 6 GSP schools was determined using shelf measurements of snack foods. Unhealthy outlets greatly outnumber healthy outlets (mean relative density 15.6%, median 19.1%). The majority of outlets stock predominantly highly processed food and drink. Study areas are dominated by unhealthy food outlets and highly processed food.

Bangladeshi women's experiences of infant feeding in the London Borough of Tower Hamlets.

This study examined the main factors that influence Bangladeshi women living in London's decisions to partially breastfeed their children, including the influence of older women within the community. Fifty-seven women of Bangladeshi origin living in the London Borough of Tower Hamlets took part in seven discussion groups between April and June 2013. Five groups were held with women of child-bearing age and two groups with older women in the community. A further eight younger women and three older women took part in one-on-one interviews. Interviews were also carried out with eight local health care workers, including public health specialists, peer support workers, breastfeeding coordinators and a health visitor. The influences on women's infant feeding choices can be understood through a 'socio-ecological model', including public health policy; diverse cultural influences from Bangladesh, London and the Bangladeshi community in London; and the impacts of migration and religious and family beliefs. The women's commitment to breastfeeding was mediated through the complexity of their everyday lives. The tension between what was 'best' and what was 'possible' leads them not only to partially breastfeed but also to sustain partial breastfeeding in a way not seen in other socio-cultural groups in the United Kingdom.