Table 1 Characteristics of studies

1

Abel 2015 [32]

NZ rural

12 Maori mothers and 10 key community stakeholders

Understand determining factors for the acceptability of the Wahakura as an infant sleeping device

Exploratory qualitative study; Interviews either at home or work; Ethics approval

Moderate

Simple, woven flax bassinet-like structure to be used in parental bed; ‘safe sleeping rules’ aimed at reducing sudden unexpected death

Practical value (safe bed-sharing, easier breast feeding, portability, versatility, convenience); cultural and spiritual value (natural fibre, sacred and healing qualities); health promotion (the process of weaving resulted in some women giving up smoking)

2

Applequist 2000 [43]

USA

52 Native American female caregivers of children with a disability recruited from three early intervention programs

Determine parental satisfaction with services

Qualitative evaluation; One time-point interviews; No ethics approval reported

Moderate

Educational and therapeutic services provided in home-based, clinical or centre-based settings, primarily by paraprofessionals

Caregivers were generally satisfied; more so with early intervention programs perceived as more family-centred. Satisfaction not correlated with provider nor family variables

3

Arney 2010 [46]

AU urban

Mothers, fathers and extended family members who supported a family member in the program 60 participants recruited by program nurses and cultural consultants

To explore Aboriginal families’ perceptions on the ‘Family Home Visiting Program’ in Adelaide SA

Qualitative evaluation; One time-point focus groups and interviews; No ethics approval reported

Weak

Home-based intervention delivered by Child and Family Health Nurses, and Cultural Consultants/ Aboriginal staff. Intensive staff training in strength- based approach, attachment, child development, and socio- emotional issues

Families valued family inclusiveness, cultural respect, strengths- based approach, flexibility to address family-identified issues, program convenience (home delivery) and Aboriginal staff as a bridge with the mainstream service

4

Atkinson 2001 [33]

AU urban

Representatives from maternal and child health services in the Indigenous community

To describe the development of a new Maternal and Child Health Program run by the Townsville Aboriginal Health Service

Qualitative exploratory study; Single time-point forum focussed on quality improvement, held August 1999; No ethics approval reported

Weak

Daily maternal and child health care plus primary health care through collaborative approach with hospital, university, health service, and Centrelink.

Breast feeding, nutrition, and smoking cessation program.

Child friendly waiting room

Increased ante-natal visits; decreased pre- term births, low birth weight, and peri-natal deaths. Need for: team approach for Indigenous mothers and infants; improved coordination of services; improved transport and education

5

Ball 2005 [34]

CAN rural

First Nations community members from three communities

To report on promising practices of integrated service models centred around early childhood care and development programs through a community development approach

Series of group forums and individual interviews; No ethics approval reported

Weak

Multi-purpose centre at public school: child care, parent education and support; service referral; Nutritious meals; preventive dental care; Primary health care incl. immunisation, vision, hearing, and speech screening; Specialist services incl. support for children with foetal alcohol spectrum disorder; speech therapy; Cultural activities; Social services; Community kitchen and gathering space. Training program in child and youth care

Service centres can become a focal point for mobilising community involvement in supporting young children and families; social cohesion; a cultural frame around service usage to inform external service providers and offer cultural safety for community members

6

Barlow 2015 [23]

USA rural

Pregnant American Indian teens

322 participants recruited from Indian health service clinics; women, infants, and children nutrition programs; schools, and by word of mouth

Intervention Group n = 159; Control Group n = 163

To assess the efficacy of the ‘Family Spirit’ intervention for parenting, and for maternal and child emotional and behavioural outcomes

Randomised controlled trial (RCT) – Family Spirit intervention plus optimised care compared with optimised care only; outcomes assessed at baseline (28 to 32 weeks of gestation), 36 weeks of gestation; and 2, 6, 12, 18, 24, 30, and 36 months postpartum through maternal self-report questionnaires, in-person interviews, audio computer-assisted self-interviews, observational data, and medical chart data; Ethics approval

Strong

43 structured pre-natal and infant care lessons in “positive parenting” addressing maternal behaviour and mental health problems; delivered in participant’s homes by American Indian paraprofessional health educators; Educators received > 500 h training

Parents: Increased parenting knowledge and locus of control; fewer depressive symptoms, and externalising problems; lower use of marijuana and illegal drugs

Children: Fewer externalising, internalising, and dysregulation problems

Barlow 2013 [22]

To assess parenting and maternal and early child behavioural outcomes from pregnancy to 12 months postpartum

Outcomes assessed at baseline (32 weeks’ gestation) and 2, 6, 12 months postpartum

As above. Increased home safety attitudes

Mullany 2012 [25]

Describes rationale, design, methods, and baseline results of the Family Spirit intervention

Community-based participatory research In January 2007, eligibility criteria – minimum gestational age was increased to 32 weeks

Moderate to high scores in maternal psychological and behavioural risks; higher lifetime cigarette use

Walkup 2009 [26]

167 participants recruited from pre-natal, and school-based clinics, between May 2002 and May 2004.

Intervention Group n = 81; Control Group n = 86

15 months’ pilot trial

Outcomes assessed at baseline (28 weeks’ gestation); 2, 6, and 12 months postpartum.

Follow up completed in May 2005.

25 home visits/1 h each.

Breastfeeding Nutrition program: 23 home visits/1 h each

Mothers reported increased parenting knowledge Decreased infantile externalising behaviour and separation distress

Barlow 2006 [24]

53 participants recruited between July 2001 and Feb 2002 from four American Indian health service catchments; Intervention Group n = 28; Control Group n = 25

9 months’ pilot trial

Follow-up data available for only 19 intervention and 22 control participants

Breastfeeding education program only; 25 home visits and 41 discrete lessons provided from 28 weeks’ gestation to 6 months postpartum

Increased parenting knowledge, skills, and involvement.

Mothers in the intervention group experienced a larger drop in depressive symptoms.

7

Black 2013 [35]

AU rural

167 disadvantaged Aboriginal children, aged 0–17 years with nutrition risk identified and recruited by Medical services staff

To evaluate the impact of a fruit and vegetable subsidy program, delivered by an Aboriginal Medical Service, on short-term health outcomes

Uncontrolled before & after study; Outcomes measures assessed after 12 months; Clinical assessments, health record audits and blood testing; Ethics approval

Weak

Provision of a weekly box of subsidised fruit and vegetables linked to preventative health services and nutrition promotion

Fewer visits to health services, hospital emergency department attendances, and prescription in oral antibiotics. A small but significant increase in mean haemoglobin levels but no change in the proportion with iron deficiency and anaemia

8

Blinkhorn 2012 [36]

AU

Aboriginal Health workers from six health services will recruit 72 families with a child six months of age

To monitor a longitudinal oral health education program to assess the effect on dental caries, feasibility, and to inform the design of a confirmatory randomised phase three trial

Study protocol - longitudinal study Repeated measures over 2 years on parental knowledge and views on acceptability of the program; Data on dental caries will be compared with data from a historical reference group; Ethics approval

N/A

Aboriginal Health Workers (AHWs) will provide advice on diet, oral health products, child specific dental advice, education material, and screening for early childhood caries; invite mothers to ACCHS clinic; home visits if appointments missed or difficulties attending clinic

N/A

9

D’Espaignet 2003 [37]

AU remote

Aboriginal pregnant women; 7730 hospital-based live births between 1988 and 2001 analysed

To assess the effect of ‘Strong Women, Strong Babies, Strong Culture’ health education program on birth weights

Controlled before and after study; Group 1 commenced program in 1993; Group 2 in 1996 and 1997; Ethics approval

Weak/Moderate

Senior Aboriginal women provided advice and encouragement about healthy pregnancy management in relation to nutrition (including bush foods), safe practices such as alcohol and smoking abstinence, reinforcing the need to seek adequate and timely medical help and to take prescribed medicines

Significant improvements in birthweight in Group 1, but no significant change in Group 2; Ante-natal care aspects could not be assessed due to incomplete electronic data collection

10

Di Lallo 2014 [44]

CAN

First Nations pregnant women 281 women attended the program between November 2005 and February 2009

Evaluate the Aboriginal Prenatal Wellness Program

Program evaluation Pre and post survey on participant satisfaction No ethics approval reported

Weak

Service provided on a continuum of care involving community agencies, health professionals, social workers, life support counsellor and Aboriginal community Elders

General high satisfaction. Improved access to ante-natal health care that is culturally sensitive, inclusive, efficient and supportive. Increase in returning clientele. Increased breast feeding. Decreased maternal smoking and drinking

11

Edmunds, 2016

AUS remote

170 Aboriginal pregnant women and mothers and babies to 6 months post- partum from Cape York communities, Aboriginal Health Workers

Evaluate the impact of the Baby Basket program as implemented in Cape York by Apunipima Cape York Health Council, and aspects of the program that are transferable to other regions and other groups

Mixed method study: qualitative grounded theory methods based on interviews and focus groups with women who received Baby Baskets, family members, and healthcare workers.

Quantitative comparative analysis of routine indicators of Apunipima communities and nearby Gulf and Torres; and Baby Basket surveys. Cost analysis to estimate the resources required to deliver the Baby Basket

Costing: Moderate

Qualitative: Moderate

Quantitative: Weak

Encourages early and frequent attendance at antenatal clinics and regular postnatal check- ups. Engagement is facilitated by delivery of three Baby Baskets including five food vouchers to women.

Baskets are delivered in the first trimester, immediately prior to birth and post birth. Education about healthy choices around smoking, alcohol and diet.

The core concern of implementation was termed working towards an empowering family- centred approach. Compared with the control sites: Apunipima sites had a higher proportion of early and more frequent antenatal visits, lower levels of iron deficiency in pregnant women, declining levels of faltering growth in children. But also increasing smoking in pregnant women and inconsistent results about education. Cost per participant was modest ($874).

McCalman, 2015 [29]

McCalman, 2014 [28]

11

Elliott 2012 [38]

AU remote

Aboriginal parents and carers of all children born in the Fitzroy Valley region, Western Australia between 2002 and 2003

Describe strategy development for the diagnosis and prevention of Foetal Alcohol Spectrum Disorders (FASD); and the support for parents and carers of affected children through individual treatment plans

Descriptive study Information about antenatal exposures; early life trauma; and health and development of parents and carers was obtained via a medical checklist; Ethics approval

N/A

Aboriginal organisations partnered with researchers to successfully lobby for restricted access to alcohol; conducted a FASD prevalence study following extensive community consultation and consent. Program includes community education; support for parents and carers; advice for teachers

Data will be used by the community to advocate for improved services and new models of health care

12

Harvey- Berino 2003 [39]

USA

43 mothers and their preschool Native- American children

To determine whether maternal participation in an obesity prevention plus parenting support program was feasible and effective in reducing the prevalence of childhood obesity

RCT comparing obesity prevention & parenting support with parenting support alone; 40 participants assessed; 20 each in treatment and control groups; Recruitment via media advertisements, day care centres, nutrition program, self-referral, informal networking in community; Outcome measures assessed at baseline and 16 weeks; Ethics approval

Moderate

11 parenting lessons conducted over 16 weeks in the parent’s home; training provided for peer educator and project director

Decreased weight gain in children in the obesity prevention & parenting support group. Inconclusive data on whether parents posing restrictions on feeding influenced weight gain

13

Homer 2012 [40]

AU urban

353 Aboriginal and Torres Strait Islander pregnant women who attended the Malabar service and gave birth during 2007 and 2008

To evaluate whether and to what extent the Malabar Community Midwifery Link Service was meeting the needs of women clients and staff

Before and after study; Repeated measures of clinical data and data on smoking/alcohol use; Focus-group data at one time-point of womens’ satisfaction with the service; Ethics approval

Moderate (qualitative component); Weak (quantitative component)

Midwifery continuity of care during pregnancy, labour and birth; and post-natally with referral to child health services after discharge; service is either hospital or home based; transport provided for better access

Women felt the service provided ease of access, continuity of care and carer, trust and trusting relationships. Early access to pregnancy care. Reduced smoking during pregnancy. Health promotion programs developed that target smoking and alcohol consumption during pregnancy

14

Munns 2010 [41]

AU remote

Parents, carers, and ante-natal clients of children aged 0–3 years living in the town of Halls Creek, Western Australia

To describe the introduction of an Indigenous home visiting parent support program to enhance promotion of behavioural and attitudinal changes to parenting

Case study/program description; A group of strong men and women as home visitors; working in conjunction with community child health nurses and midwives; No ethics approval reported

N/A

Enhanced promotion of behavioural and attitudinal changes to parenting; monthly 1 h home visits by Indigenous peer support team (extended and in other locations if needed); may be two or three home visitors to accommodate different languages, family, and cultural issues; health promotion through pictorial handouts; Inclusion of culture and lore. Train the trainer program

Not reported

15

Poole 2000 [42]

CAN urban

18 pregnant Aboriginal women with substance use problems who accessed the service in 1988; tracking of 12 clients who accessed services July 1999 and December 1999; surveys completed by 10 staff and three Council members; survey completed by 21 key informants

Evaluation of the Sheway Program

Qualitative program evaluation; Art expression combined with a focus group to capture women’s perspectives on the service. File review of birth and health outcomes.

Data compared with information on women clients from two previous years. No ethics approval reported

Moderate

Daily hot nutritious lunches, food coupons, food bank hampers and nutritional supplements, bus fare for appointments, formula, nappies, clothing, equipment and other items for newborn infants, outreach and home visits, recreational and creative programs, nutrition counselling and support, alcohol and drug counselling, methadone prescribing, support in developing/ improving parenting skills, advocacy on housing and legal issues

Improved nutritional outcomes, decreased substance misuse, improvement in housing, lower rates of child apprehension by the Ministry of Children and Family development, healthier birth weights, up-to date immunisations

16

Thomas 2015 [45]

AU

12 service managers, paediatric registrars, early childhood health nurse, midwife, Aboriginal health education officer, speech pathologist, manager of parenting support program

To explore the views of service providers on how paediatric outreach services work in partnership with other services, Aboriginal families and the community, and how those partnerships could be improved

Qualitative one-point in time study; In-depth semi- structured interviews, focus groups; Ethics approval

Moderate

Formal and informal approaches to facilitate relationships between service providers and families, ensuring children receive quality care when and where they need it. Partnerships founded on a culturally appropriate model of care that was non-judgemental, based on trust and respect, and recognised holistic health and wellness

More time for consultations and more opportunity for follow-up than would normally occur in the outpatient setting; leadership was essential component of effective partnerships

17

Turner 2007a [30]

AU urban

51 Indigenous families; n = 26 treatment group, n = 25 control group (waitlist for 8 weeks)

To assess the effectiveness and cultural appropriateness of the Triple P parenting program

Randomised group design with repeated measures; outcome measures assessed at 6 months; recruitment through home-based interview; no ethics approval reported

Moderate

Eight-session program, using active skills training process to help parents acquire new knowledge and skills.

High consumer satisfaction; break down of obstacles in accessing mainstream services; significant decreases in problem child behaviour; significant decrease in reliance on dysfunctional parenting practices

Turner 2007b [31]

Non-Indigenous researchers

To reflect on a culturally sensitive adaptation of a mainstream intervention, the “Triple P Parenting Program”

Reflective paper No ethics approval reported

N/A

Appointing project staff can be complex and sensitive. Need community acceptance and support; sensitivity to participant’s issues; flexible access to services; strategies to overcome literacy and language barriers; awareness that complex family issues may impact group dynamics; sharing of outcomes with community