Exploring Cultural and Clinical Factors Contributing to Aboriginal and Torres Strait Islander Women’s Resilience: A Study Utilising the Baby Coming You Ready Program

Trish Ratajczak

Introduction: Limited evidence is available from Aboriginal and Torres Strait Islander (hereafter Aboriginal) women’s perinatal perspectives, self-efficacy and resilience when perinatal mental health is assessed. Currently, perinatal screens and assessments focus on Aboriginal women’s risks. This study has explored cultural and clinical factors contributing to Aboriginal women’s perinatal mental health, using the Baby Coming You Ready (BCYR) digital platform. Methods: The study was conducted on Noongar Boodjar (Perth, Western Australia) using an Aboriginal Participatory Action Research (APAR) framework. Quantitative and qualitative methods have been used to explore cultural and clinical factors contributing to perinatal self-efficacy and resilience from an Indigenous perspective. As described by Bessarab and Ng'andu (2010) I have used the research yarning technique. The yarning technique encompassed different types of yarning and was chosen as a culturally safe data collection process to privilege Aboriginal women’s voices. A total of eight Aboriginal women, who had completed BCYR in the ante/postnatal period were recruited by convenience sampling. Thematic analysis of the qualitative data was conducted by two Aboriginal and two highly experienced qualitative non-Aboriginal researchers using inductive and deductive coding, commencing with independent coding followed by member checking and consensus. Quantitative de-identified data was drawn from specified images relating to domains of social, emotional, and spiritual wellbeing as selected by women during their assessment using the digital platform. The data comprised images selected by the women was extracted along with associated Kessler K5+2 scores from the total BCYR cohort (n=326). Descriptive statistics (including frequencies and percentages) were used to summarise key variables and relative risk with 95% confidence intervals (CI) calculated for factors associated with a low/moderate K5+2 score. Results: Quantitative outcomes strongly triangulated the qualitative outcomes. Six primary themes emerged from the qualitative data analysis revealing patterns of resilience in the qualitative cohort (n=8) alongside clinical factors that contribute to self-efficacy. Strengths-based quantitative analyses revealed several key factors associated with a low/moderate K5+2 score, with RR (95% CI) varying between 1.23 (1.01, 1.52) for women who had love and support during childhood and 3.03 (1.95, 5.26) for women who felt that they knew they make their family proud. Conclusion: Findings confirm the BCYR program recognises and supports Aboriginal women’s resilience, self-efficacy, and strengths in the perinatal period. It provides culturally appropriate ways of assessing and enhancing the mother's cultural strengths. The BCYR program has the potential to inform the implementation of effective, culturally safe care for Aboriginal women, children, and families to support enhancing existing strengths and address risks. Recommendation: Embedding BCYR into maternity health care settings and policies will ensure strengths-based culturally safe care is provided to all Aboriginal women in the perinatal period to ensure improved maternal and infant outcomes and Close the Gap Targets One and Two.

Exploring Cultural and Clinical Factors Contributing to Aboriginal and Torres Strait Islander Women’s Resilience: A Study Utilising the Baby Coming You Ready Program

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