Table 2 Themes contributing to program success
Relationship Building |
|---|
• Three types of relationships identified—staff-to-client, staff-to-staff, and community networks (other agencies, programs, and services) [1, 3, 5, 8, 13, 49,50,51,52,53] • Respect and trust are essential in any type of relationship building [5, 49, 54, 55] • Institutional supports such as investing time and funding are necessary for the relationship-building process [22, 29, 49, 56, 57] |
Cultural |
• “Culturally appropriate” programs were responsive to their participants and based the program on cultural elements such as the Medicine Wheel and Indigenous protective factors [8, 50, 58,59,60] • “Culturally based” programs included structural cultural adaptations, traditional approaches, and traditional ways such as traditional parenting and lifestyle practices [3, 4, 15, 28, 52, 55, 61] • Programs identifying with “cultural competency” described program providers as grounded in cultural competency through training [28, 29, 31, 62, 63] • Programs described as providing “culturally safe care” included workers reflecting on their privilege and positioning, the training and recruitment of workers, and discussing sensitive issues [14, 53, 62] • Local culture encompassed the inclusion of local protocols, such as prayer and ceremony within the program, and local cultural elements, such as the Medicine Wheel and artwork [8, 15, 52, 58, 64, 65] • Elders were included in the health program process and, specific to maternal-child programs, the involvement of senior community women [3, 14, 49, 59, 66,67,68] • Including both oral and written communication in the community language was important in the programs [15, 53, 62, 69,70,71] |
Knowledge Transmission Styles |
• For program delivery, applying oral traditions such as story (i.e., yarning) [5, 15, 28, 50] • Delivering visual program information in the form of pictures, visual aids or videos [22, 30, 53, 72, 73] • Utilizing communication styles that were easy to understand with no jargon and written in the community language 5,8,33,53,70) • Program advertising that applied unconventional methods using word of mouth and social media streams such as Facebook to advertise programs [1, 51] |
Community Collaboration |
• A range of community inclusion within the program process was used from community support and involvement to community ownership and self-determination [4, 13, 22, 29, 32, 56, 57, 68, 74] • Programs that identified community leadership, governance and self-determination demonstrated communities that took leadership and ownership over the programs themselves [1, 4, 15, 50, 58, 59, 69, 70] |
Program Approaches |
• Programs that are voluntary, eligible to all community members, and flexible [1, 3, 31, 49, 73, 75] • Family-led, holistic programs that include extended family members [5, 14, 15, 51, 59, 67, 76] • Programs focused on strengths-based approaches and building on participants’ assets [1, 5, 28, 55, 75, 77, 78] • Program incentives such as resources or gift packs for participants [22, 54, 68, 76] • Home visits and leaving the clinic setting to bring the program to the client [5, 22, 50, 53, 77] |
Staff |
• Employing Indigenous staff [5, 15, 28, 49, 50, 60, 66, 67, 69] • Employing male staff [61, 72] • Staff that are long-term [1, 55, 60, 61, 71] • Staff-to-staff knowledge exchange with two-way sharing between cultures, i.e., Indigenous and non-Indigenous [5, 13, 52] |
Operational Considerations |
• Resources such as adequate and long-term funding [3, 32, 63] • Welcoming physical space [1, 13, 29, 56, 57, 61, 66] • Provide transportation for participants [1, 8, 50, 67] • Organizational considerations within program operations such as support and training for staff [5, 13, 15, 49, 54, 61, 62, 69, 72] • Leadership and management that supports workers and collaborative approaches [8, 15, 22, 50, 52, 54, 72] • Policies at both the local level and beyond that support the work with families [14, 62] • Ongoing evaluation and improvement of programs that reflect the community and community priorities [55,56,57, 78] |