Caroline Nilson

This study addresses the self-identified health issues experienced by yorgas (women) in an Aboriginal Bindjareb (region) community in the Nyungar nation of south west Western Australia. In collaboration with yorga Elders and Leaders from the Murray Districts Aboriginal Association (MDAA), Caroline Nilson, a non-Indigenous researcher, academic and health professional, developed, coordinated, facilitated, and implemented a culturally appropriate health promotion initiative, the Bindjareb Yorgas Health Program [BYHP], which was the topic of Caroline's PhD research project.

The BYHP aims were to foster the development of personal knowledge and skills in achieving and maintaining wellness, and the strengthening of community actions towards improving health by facilitating improved individual and group health literacy. Further, the study sought an understanding of the ways in which the BYHP facilitated healthy lifestyle change in the Bindjareb yorgas and their families and whether the structure and delivery of the program provided a supportive environment for the women to engage in sustainable health promotion activities.

The BYHP was underpinned by the ideals of the Aboriginal model of health, which encompasses all aspects of a person's life (Lock, 2007). This concept places significant emphasis on social and emotional components and is linked to the sense of being Aboriginal, through connection with the environment (social and economic), community, relationships, land, the physical body and the mind, and traditional cultural lore (law) and knowledge (Nyungar kaartdijin). The BYHP study consisted of four components: nutrition and cooking classes, group fitness classes (including walking group sessions), a community vegetable garden project and health 'yarning' sessions (a culturally appropriate method of communicating about important matters), which comprised informal and formal discussions.

Twenty-two women from the two kinship groups in two towns in the research setting were invited to take part in the project. Purposive and snowball sampling were used to recruit the yorga participants and the consent processes were conducted by the yorga Elders and Leaders and resulted in 17 Bindjareb yorgas consenting to participate.

There were a total of 24 cooking and nutrition classes and all 17 participants each took part in between 3 and 22 classes. Attendance at the 33 group fitness classes varied, with 16 of the 17 participants taking part in between 1 and 29 classes; as did attendance at the 24 walking group sessions where 13 yorgas participated in between 3 and 22 sessions each. Six participants volunteered to share the vegetable garden management over a 24 week period resulting in an average weekly attendance of 5.5 visits between them. A number of yarning sessions (individual and group) were also facilitated by Caroline in collaboration with Karrie-Anne Kearing-Salmon, an Aboriginal woman Leader appointed as the research assistant.

An ethnographic action research [EAR] approach was used in the research, which combines the methodologies of ethnography, participatory techniques and action research (Tacchi, Slater & Hearn, 2003; Tacchi, et al., 2007). The data was collected with the assistance of the yorga Elders and Leaders during which time Caroline was also mentored by Gloria Kearing, a yorga Elder. Data sources included audio recorded yarning groups, audio recorded individual yarning, direct observations and participant-observations, and Caroline's personal diary notes audio recorded during fieldwork.

A narrative art project was also conducted as a culturally appropriate method of gathering data and was used as an opportunity to facilitate informal health yarning. The works of art were shared with the wider community in a public gallery exhibition, which ran for six weeks during August and September 2013.

Thematic analysis of the data was undertaken in consultation and collaboration with the selected yorga Elders and Leaders for each component of the research, and was assisted using Artichoke ™ (Fetherston, 2013), a computer-based program.

Results that have captured the main findings are presented in the thesis in a number of peer-reviewed published and under review articles and other manuscripts have been prepared and are in the process of submission.

The themes identified from the cooking and nutrition component related to experiences of overwhelming loss, acknowledging collective shame, finding change too hard, being crippled by the lack of resources, mistrust, and tensions, community control empowering individuals through engagement, learning for life purpose, and planning for community determination.

The themes derived from the group fitness component related to the loss of traditional knowledge and practices, withdrawal due to shame, community facilitation enabling enjoyment in engagement, and experiencing a sense of place and connection to land and culture.

The community vegetable garden component themes related to feelings of ownership: "deadly, unna?" (very good, isn’t it?), "ngnaailak" (belongs to us); a sense of place: "nalaru boodjar" (our own country), "kwobbrup" (a good place); reconnection to traditional land: "boodjar, mundak and ponar" (land, the bush and the seasons); pride in learning new skills: "djinanginy kaartdijin" (seeing, learning, and understanding); and hoping for continued community engagement and partnership support: "patpatan mila" (worried for the future).

The health yarning component themes related to patience in the ways of talking with the yorgas "moorditj bandjar tarwagin" (patient way of talking with us), feelings of safety to talk about health issues and coming together as equals to become strong in health; "djaliny moordidjabiny kootamiara quab" (listening to become strong in health).

The narrative art project themes related to the overall connectedness and the mobilisation of community members in coming together to consolidate relationships for their health and wellbeing; individuals coming together for their health and wellbeing, and processes in mobilising community social relationships. The additional themes related to the yorgas developing self-identity through painting their experiences and their creativity contributing to community empowerment.

In regards to sustainable lifestyle change, themes from the group fitness and cooking and nutrition components around the real challenges and barriers also emerged. The acknowledgement of shame was identified as a psychosocial barrier and previously experienced reduced health literacy was seen as having a negative impact on food security and healthy lifestyle choices. Several themes relating to the importance of a 'sense of place' and 'feelings of safety', and the 'rekindled connection to land' were threaded through all the components, particularly the vegetable garden project. These themes were critical in answering the research questions regarding community ownership and the culturally appropriate structure and delivery of the BYHP. Themes from the cooking and nutrition component also related to the impact of historical events on nutritional health of Indigenous Australians, and on the undermining effect of mistrust within the community and towards outsiders and the need to plan to achieve a real sense of community determination and address issues of limited resources. These themes were pertinent in answering the research question regarding the required community action to lead to the sustainability of the program.

The findings suggest that historical colonisation processes greatly influence current Aboriginal health and wellbeing. It has impacted on individual and community esteem and determination, resulting in feelings of inadequacy, racial demoralisation and mistrust, towards others and within their own groups. Feelings of a sense of place, the reconnection to land and culture, and a sense of safety were a common thread to have emerged from the BYHP. These correlated with further findings that identify the need for community collaboration and control. The acknowledgement of shame was identified as a psychosocial barrier influencing health literacy, food security and healthy lifestyle choices. The real challenges of change around healthy eating and physical activity were highlighted, however the sense of purpose gained through learning new skills and knowledge was found to be a key driver towards change. To achieve sustainability the findings highlighted the need for continued partnership development and ongoing planning for skills and employment opportunity and these were identified as important to achieving a real sense of community determination.