1 + 1 Project
The 1+1 = A Healthy Start to Life Project: Targeting the year before and the year after birth in Aboriginal children in remote areas was a three stage baseline, intervention and post-intervention study designed to improve maternal and infant health for remote dwelling Aboriginal families in Maningrida and Wadeye, NT, Australia. We investigated how services could be better designed to increase community involvement and improve early detection of problems and increase the effectiveness of multidisciplinary practice during pregnancy and the year after birth. This study was funded by the National Health and Medical Research Council (APP422503, $587,272), the NT Research and Innovation Board and the Helen and Bori Liberman Family. An Australian Research Council funded project (LP0669519, $373,000) in partnership with the Department of Health and Community Services and Danila Dilba Aboriginal Medical Service ($150,000) studied Indigenous families, birth and parenting which also fed into this work.
A mixed-methods health services research program of work was designed, using a participatory approach. The stakeholders included consumers, midwives, doctors, nurses, Aboriginal Health Workers (AHW), managers, policy makers and support staff. Data were sourced from: hospital and health centre records; perinatal data sets and costing data sets; observations of maternal and infant health service delivery and parenting styles; formal and informal interviews with providers and women and focus groups. Studies examined: indicator sets that identify best care, the impact of quality of care and remoteness on health outcomes, discrepancies in the birth counts in a range of different data sets and ethnographic studies of ‘out of hospital’ or health centre birth and parenting. A new model of maternity care was introduced by the health service aiming to improve care following the findings of our research. Some of these improvements introduced during the five-year research program, that could be evaluated in the short term, including cost, were evaluated.
Cost effective improvements were made to the acceptability, quality and outcomes of maternity care. However, our synthesis identified system-wide problems that still account for poor quality of infant services, specifically, unacceptable standards of infant care and parent support, no apparent relationship between volume and acuity of presentations and staff numbers with the required skills for providing care for infants, and an ‘outpatient’ model of care. Services were also characterised by absence of respected and influential Aboriginal leadership. Most concerning however was inadequate coordination between remote and tertiary services that is essential to improve quality of care and reduce ‘system-introduced’ risk.
Steering Committee meeting in Maningrida
Access challenges in remote Australia
Steering Committee meeting in Darwin
Taylor, A., Johns, G., Williams, G., & Steenkamp, M. (2011). The ‘Problem’ of Indigenous Migration in the Globalised State. In D. Carson, R. Rasmussen, P. Ensign, L. Huskey & A. Taylor (Eds.), Demography at the Edge: Remote human populations in developed nations (pp. 163-188). Farnham, United Kingdom: Ashgate Publishing Ltd.
Kildea, S. and M. Wardaguga, Childbirth in Australia: Aboriginal and Torres Strait Islander Women, in Childbirth across cultures, ideas of pregnancy, childbirth and the postpartum period in many of the worlds cultures, H. Selin and P. Stone, Editors. 2009, Springer: Amherst. p. 275-287.
Prime Minister’s Science, Engineering and Innovation Council (PMSEIC) (2008). PMSIEC Working Group on Aboriginal and Torres Strait Islander Health focusing on Maternal, Fetal, and Postnatal, The Health of the Adult Begins in the Womb, A Report of the Working Group, 2008, Canberra. (Bar-Zeev, S., Barclay, L., Carapetis, J. & Kildea, S. All contributing authors to this report)
Josif, C., Kildea, S., Gao, Y., Barclay, L., Steenkamp, M., Bar-Zeev, S., et al. (2012). Evaluation of the Midwifery Group Practice Darwin Final Report: Midwifery Research Unit, Mater Medical Research Institute and Australian Catholic University.
Peer-refereed journal articles
Risk factors for Preterm and Low Birth Weight Babies among Aboriginal Women from Remote Communities in Northern Australia. Women and Birth, 30(5), 398-405
Kildea, S., Gao, Y., Rolfe, M., Tracy, S., Boyle, J., & Barclay, L. (2017)
Perinatal outcomes among young Indigenous Australian mothers: a cross-sectional study. Birth, 44(3), 262-271
Steenkamp, M., Rumbold, A., Boyle, J. Moore, V., Davies, M., & Kildea, S. (2017)
The quality of health services provided to remote dwelling Aboriginal infants in the top end of northern Australia following health system changes: a qualitative analysis. BMC Pediatrics, 17(1), 93
Josif, C. M., Kruske, S., Kildea, S. V., & Barclay, L. M. (2017)
Remote links: redesigning maternity care for Aboriginal women from remote communities in Northern Australian; a comparative cohort study. Midwifery, 34, 47-57
Kildea, S., Gao, Y., Rolfe, M., Josif, C., Bar-Zeev, S., Steenkamp, M., Kruske, S., Williams, D., Dunbar, T., & Barclay, L. (2016)
A cost-consequences analysis of a Midwifery Group Practice for Aboriginal mothers and infants in the Top End of the Northern Territory, Australia. Midwifery, 30(4), 447-455
Gao, Y., Gold, L., Josif, C., Bar-Zeev, S., Steenkamp, M., Barclay, L., Zhao, Y., Tracy, S., & Kildea, S. (2014)
Improving Aboriginal maternal and infant health services in the ‘Top End’ of Australia; synthesis of the findings of a health services research program aimed at engaging stakeholders, developing research capacity and embedding change. BMC Health Services Research, 14, 241
Barclay, L., Kruske, S., Bar-Zeev, S., Steenkamp, M., Josif, C., Narjic, C., Wardaguga, W., Belton, B., Gao, Y., Dunbar, T., & Kildea, S. (2014)
Factors affecting the quality of antenatal care provided to remote dwelling Aboriginal women in northern Australia. Midwifery, 30(3), 289-96
Bar-Zeev, S., Barclay, L., Kruske, S., & Kildea, S. (2014)
No more strangers: investigating the experiences of women, midwives and others during the establishment of a new model of maternity care for remote dwelling Aboriginal women in Northern Australia. Midwifery, 30(3), 317-23
Josif, C., Barclay, L., Kruske, S & Kildea, S. (2014)
Use of maternal health services by remote dwelling Aboriginal women in northern Australia and their disease burden. Birth: Issues in Perinatal Care, 40(3): 172-181
Bar-Zeev S, Barclay L, Kruske S.,Bar-Zeev, N., Gao, Y., & Kildea, S. (2013)
Adherence to management guidelines for growth faltering and anaemia in remote dwelling Australian Aboriginal infants and barriers to health service delivery. BMC Health Services Research, 13, 250
Bar-Zeev, S., Kruske, S., Barclay, L., Bar-Zeev, N. & Kildea S. (2013)
How participatory action research supported improvements to the postnatal discharge summary system used for remote dwelling Aboriginal mothers and infants in the Top End of Australia. Action Research, 10(4), 387-405
Josif, C., Barclay, L., Bar-Zeev, S., Kildea, S. & Brittin, M. (2012)
Clustering in Northern Territory midwives data for 2003-2005. Health Information Management Journal, 43(1), 37-41
Steenkamp M. (2012)
Measuring what matters in delivering services to remote-dwelling Indigenous mothers and infants in the Northern Territory, Australia. Australian Journal of Rural Health, 20(4), 228-237
Steenkamp, M., Rumbold, A., Kildea, S., Bar-Zeev, S., Kruske, S., Dunbar, T., & Barclay, L. (2012)
A population-based investigation into inequalities amongst Indigenous mothers and newborns by place of residence in the Northern Territory, Australia. BMC Pregnancy and Childbirth, 9(12), 44
Steenkamp, M., Rumbold, A., Barclay, L., & Kildea, S. (2012)
Can we count? Enumerating births in two remote Aboriginal communities in the Northern Territory of Australia, Australian and New Zealand Journal of Public Health,36(3), 281-284
Steenkamp, M., Johnstone K., & Bar-Zeev, S. (2012)
Growing Up Our Way: The First Year of Life in Remote Aboriginal Australia. Qualitative Health Research, 22(6),777-787
Kruske, S., Belton, S., Wardaguga, M., & Narjic, C. (2012)
From hospital to home: The quality and safety of a postnatal discharge system used by remote dwelling Aboriginal mothers and infants in the Top End of Australia. Midwifery, Jun;28(3), 366-73
Bar-Zeev, S., Barclay, L., Farrington, C. & Kildea, S. (2012)
Use of health services by remote dwelling Aboriginal infants in tropical northern Australia: a retrospective cohort study. BMC Pediatrics 12,19
Bar-Zeev, S., Kruske, S., Barclay, L & Bar-Zeev, N., Carapetis, J. & Kildea, S (2012)
"Niyth Niyth Watmum (The Quiet Story): Exploring the experiences of Aboriginal women who give birth in their remote community." Midwifery, 27(5), 634-41
Ireland, S., Narjic, CW., Belton, S., & Kildea, S. (2011)
‘Closing the Gap’: How maternity services can contribute to reducing poor maternal infant health outcomes for Aboriginal and Torres Strait Islander women. Rural and Remote Health, Jul-Sep,10(3),1383
Kildea, S., Kruske, S., Barclay, L., Tracy, S., & Barclay, S. (2010)
Pragmatic indicators for remote Aboriginal maternal and infant health care – why it matters and where to start. Australian and New Zealand Journal of Public Health, 34(s1), S5-S8
Steenkamp, M., Bar-Zeev, S., Rumbold, A., Barclay, L., & Kildea, S. (2010)
A Rural Birth Index for Australia? Australian Journal of Rural Health, 18(2), 85-86
Kildea, S. & Stratagos, S.(2010)
Barclay, L., & Gao, Y. (2011). 1+1 = A Healthy Start to Life. PHC RIS infornet, 15(5), 8.
Conference paper presented
Kildea, S, Barclay, L., Kruske, S., Gao, Y., Josif, C., Steenkamp, M., Bar Zeev, S. Getting the right start in life… a pearl of an idea! The 30th National CRANAplus Conference, Remote Pearls of Wisdom, Carins, 24 September 2012
Steenkamp, M. & Barclay, L. (2011) Looking at morbidity patterns for Aboriginal women and infants in the Northern Territory of Australia – why is this useful for midwives? International Confederation of Midwives (ICM) 29th Triennial
Congress, Durban, South Africa, June 19-23 2011.
Bar-Zeev, S. & Kildea, S. (2011) Utilisation of maternal health services by remote dwelling Aboriginal women from Australia’s Top End. Royal Australian and New Zealand College of Obstetrician and Gynaecologists (RANZCOG) Indigenous Women’s Health Meeting, Cairns, Australia
Barclay, L., Bar-Zeev, S., Farrington, C., Kildea, S., Kruske, S. (2011) Redesigning maternal and infant health care for remote Australian Aboriginal Communities: Findings from a health services improvement study (symposium) International Confederation of Midwives 29th Triennial Congress, Durban, South Africa
Bar-Zeev, S. & Kruske, S. (2010) What happens during the 1st year of life? Health service utilization by remote dwelling Aboriginal infants. CRANA (Council of Remote Area Nurses of Australia) National Conference, Adelaide, Australia.
Farrington, C. (2010) “No More Strangers” Evaluation of the Midwifery Group Practice Darwin Breathing New Life into Maternity Services Conference Alice Springs July 2 – 3 2010
Kildea, S. (2010) Improving Aboriginal maternal infant health through participatory action research – a case study in health system reform. Presented to the National Maternity Council on 18 June 2010, Darwin.
(Invited Speakers) Bar-Zeev, S., Curry, J., Kildea, S., Barclay, L. and Farrington, C. (2010). Patient Journey Modelling Experiences: Remote Aboriginal Maternity Services in the Top End of Australia. Interdisciplinary modelling for improved patient centric care conference. Ontario, Canada.
Belton, S. and C. Narjic (2009). Pathways and Experiences: Indigenous Women and the Maternity System in the Northern Territory’. Australian College of Midwives. Adelaide.
Ireland, S. and C. Narjic (2009). Niiyith Niyith Watman - The Quiet Story Australian College of Midwives. Adelaide.
Belton, S. and C. Narjic (2009). Pathways and Experiences: Indigenous Women and the Maternity System in the Northern Territory’. Public Health Association of Australia. Canberra.
Ireland, S. and C. Narjic (2009). Niiyith Niyith Watman- The Quiet Story. Public Health Association of Australia. Canberra.
Kruske, S 2009: Connecting with Women through Cultural Differences: Australian College of Midwives Conference Adelaide, September 2009
Kruske S, 2009: Child Rearing and Child Development – what’s the connection?: Growing Together Conference, Australian Association of Maternal, Child and Family Health Nurses, April 2009
Kruske S, 2009: Why Culture Gets in the Way: exploring notions of difference, Growing Together Conference, Australian Association of Maternal, Child and Family Health Nurses, April 2009
Kruske S & Murakami-Gold L, 2008 Working in Partnership with Aboriginal Families (invited workshop). Australian Association of Infant Mental Health Conference, Adelaide. November 2008
Steenkamp M, Bar-Zeev S and Johnstone K. Can we count? – A case study of two remote Aboriginal communities. Public Health Association of Australia 40th Annual Conference, 27-29 September 2010, Adelaide, South Australia. (Poster)
Steenkamp M and Barclay L. Improving health services for remote-dwelling Aboriginal mothers and infants in the Northern Territory – establishing community-level indicators for effective monitoring. Health in transition. Researching for the future. The 4th International Conference on Community Health Nursing Research, 16-20 August 2009, Adelaide, South Australia.
Steenkamp M, Kildea S, Bar-Zeev S and Kruske S. Establishing indicators to assess health services for remote-dwelling Aboriginal mothers and infants. Extending the Boundaries. Casemix Conference 2008, 16-19 November 2008, Adelaide, South Australia.
Invited Speaker, Kildea S. Improving the Social Determinants of Indigenous Health: Working Beyond the Health Sector: Improving maternal infant health care, 30th -31st March 2010. Mercure Hotel Brisbane.
Keynote Address, Kildea S: Indigenous women and birthing: the risk/choice paradox, Perinatal Society of Australia and New Zealand, 13th Annual Congress, Darwin, 19-22, April 2009.
Keynote Address, Kildea S: ‘Culture of fear: working with Aboriginal and Torres Strait Islander women to reframe risk in pregnancy’ Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Australian Indigenous Women’s Health Meeting, Darwin, 14-16 August 2008.
Invited Speaker, Kildea S: Improving Social Determinants of Indigenous Health 30th March 2010. Mercure Hotel Brisbane
Invited Speaker, Kildea S: Women’s & Children’s Hospitals Australasia 2009 Annual Conference, “The Times they are a-Changin: Engaging in Health Care Reform” ‘Closing the Gap How can maternity services contribute?’ November 9th – 13th 2009, Sebel & Citigate, King George Square, Brisbane.
Invited Speaker, Kildea S: An International Research Symposium on Rural Maternity Care, Centre for Rural Health Research, April 23– 24, 2009, Whistler, BC, Canada
Kildea S. Future Birth Tour, ‘Making a Difference for Aboriginal and Torres Strait Islander Families’ Melbourne, March 26, Sydney, March 27, Brisbane, March 28, 2009
Barclay, L., Kildea, S., Kruske & Bar-Zeev, S.J (2007) Breaking the Cycle. Prime Minister’s Science, Engineering and Innovation Council Working Party on Aboriginal and Torres Strait Islander Health, Sydney, Australia