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The Use of Co-Design Principles and Process to Inform Community Health Program and Implementation of Physical Activity Program Within Aboriginal Communities

Literature Review of Applying Experience-Based Co-Design with Vulnerable Populations

The Australian population enjoys good health, while Aboriginal and Torres Islander people suffer a high risk of injury and disease. The life expectancy is lower than non- Aboriginal people by 10 years (Farrington, 2016). In Australia, Aboriginal and Torres Islander people account for 4% of the population (Mulvale, 2016). In a recent survey, it was observed that 56% of indigenous populations living in remote areas have reported levels of recreation, sports, and fitness as low (Mulvale, 2016). The poor participation rates can be included as fear of exploitation and lack of education as a challenge for the community that is taken on mistrust. Solitary physical activity provides relaxation in the urban population.

Co-design is increasingly used in health research and combines end-user and researchers as equal matrix partners (Jessup, 2018). Co-design will facilitate a task-focused approach and promote equity. The co-design process, in its various stages, addresses solutions that creates opportunity platform. The program design for physical activity can demonstrate an innovative way to approach and engage the Aboriginal community by improving cultural identity and self-esteem. Co-design principles create the development of staff and patient experience to design solutions to local problems. This approach creates solutions in the local context that undertakes stakeholder expectations and need. Co-design ensures local ownership and harness the creativity of staff and manager. The solution designed is acceptable and provide both users acceptability (Farrington, 2016). The use of co-design in health program benefit shared values and is a cyclical process with understanding, developing solutions, and testing ideas. A co-design model can be valuable in promoting physical activity engagement that will require a participatory program for the indigenous population. The focus on physical activity among Aboriginal and Torres Strait Islander will have a significant impact on the Aboriginal community in their physical health wellbeing and improving social factor and community connectedness. It was observed that the urban indigenous population has embedded physical activity as a significant impact in family and community. The development of co-design lead facilitates the success of the program.

 According to Brien (2020), the aboriginal community engagement was limited to hunting. The diversity in the indigenous population observed taking exercise was not considered as culturally relevant. Structural environment issues such as unsafe and dependence on mobility are a barrier for physical engagement for the Indigenous population. Providing appropriate equipment and organized activity plan in remote areas in Australia will remove the barrier for physical activity and non-participation. Family participation and peer support in participation. The inclusion of indigenous community people in facilitating the program as a member of the community will enable successful program implementation. Principle investigator of the community will enable participation. Co-design for weekly sessions and self-care strategies.

The use of co-design is for participatory research and taking into account the culturally suitable partnership. Development of culturally rich programs by pilot services such as semi-structured interviews and focus groups. Using high confidentiality for community engagement in addressing mental health issues, chronic illness stigma is important. Use of touch points for communication and collaboration for youth based experience in communication and collaboration for impeding quality (Mulvale, 2019).The touch point that resonated most for youth, and which was validated by youth and selected for co-design, was that poor communication and collaboration can impede quality care. The components of communication and collaboration across services that strongly influenced the quality of CYMHS were identified in the youth experience

Physical activity within Aboriginal and Torres Strait Islander people will act as a remedy for disadvantaged by providing an opportunity for a level playing field for social mobility. The traditional outlook on the Indigenous population is limited to the portrayal of the community as ill-disciplined and rash. The community engagement process involving an interview and focus group contribute to intervention. The implementation of distinct programming and guidelines will improve the cultural sensitivity of individuals. The local designing of physical activity with the indigenous community will reflect community views on health risk and wellness. Implementation of physical activity programs should be culturally adaptive that adhere to community value and cultural attributes. Interventions that facilitate exercise sessions will create a more appropriate level of indigenous literacy.

Language and communication are key to increase familiarity and are identified as basic considerations in co-designing activities and trainer appointment. YNSW government agencies have their client and improve service in the community sector. Co-designing is identified as a narrative theory for vale of openness and empowerment of the Aboriginal community (Mulvale, 2016). The co-design process can facilitate the inclusion of accessibility, communication, and confidentiality. The community-based participation incorporates indigenous knowledge and social system by social system to achieve sustainable development. Healthcare team members develop different aspects of work and all teamwork towards giving service and users working in a team (Shilton, 2014). 

Patient representative and advocates in the room for improving the healthcare system and involvement of patient representatives. Clapham suggested involving Aboriginal people as community brokers to ensure Aboriginal control and building capacity for Aboriginal health workers. Community members engaged in co-designing an evaluation will increase awareness that will make the designing process more appropriate. The workshop for staff for the co-designing process will allow participants in addressing the information gap (Mulvale , 2016). The vulnerable population such as younger community members with mental issues experience stigma while sharing experience. Creating an equal status in a co-design event will enable a positive group attitude. Scheduling of breaks and paying attention and counseling support in health programs are essential for progress.

The experience base design process as a co-designing process includes visual media and conducting group work. Experiencing diversity and acknowledging experience helps in a positive impact on health groups. Offering participants and inclusion of holistic experience will increase the comfort of the participants. Co-design is effective in infirming about health programs and ensuring service users use authentic decisions. A supportive environment fosters a strong relationship and creates an environment for core work in the organization. A good practice program enables community program for the project review process for the design process. A balanced way is developed in the healthcare system for a wider social context and doctor-patient consultation.

Sushames (2016) draws a comparison between community-based practice in incorporating vulnerable communities and experience-based co-design. Co-design focus on individual patient and re-design process of the varied level that will be effective in informing the health care program. The co-design process uses the short term and valuable opportunities for stakeholders to voice on health care programs. Australian Indigenous population has largely based on hunter lifestyle and has incorporated; the daily activity only involved the food and resources while maintaining cultural practice. The inclusion of mainstream activity as a focus on more traditional activity and family activity will be mainstream in focus. The implementation of physical activity and group fitness classes will create a unit group and self-reported measure for targeting physical activity that will promote equality and relevant to their tradition and culture.

Physical activity is defined as a bodily movement that requires energy as expenditure. It has an important role in health outcomes for the level of participation for cultural implications for Indigenous context. In Australia, the physical expenditure on health care is relatively high. The change in physical activity can be broadly classified as community and health aspects for land and health aspect that will be more engaging and create inbound participation among Indigenous’ youth who consider physical activity as a modernized concept. As defined guidelines for the physical activity for cultural information and draw on the remote accessibility for community consultation for the development of the appropriate program for Indigenous perspectives through community strength assessment.

The current physical activity level is the National Aboriginal and Torres Strait Islander people as 64% of children have been employed in some form of activity. The percentage among males has been 63% 65% respectively (Sushames, 2016). The health disadvantage can be viewed with the historical origin and social determinants of health. Broadly design community responsibilities and obligations that have an impact on the participants should be implemented to minimize the burden on individuals for communication of physical activity programs. Co-design for culturally acceptable and participatory prices can support change will ensure community improvement for stakeholders to investigate confidentiality and overcome economic barriers. Developing of co-design model on consideration of appropriate and sophisticated measurement tools and the use of physical activity interventions might be most sustainable and effective. The design of health programs through the socio-ecological model will evaluate the impact of the local community and gain a greater understanding of how different factors impact addressing health concern and social stigma (Cooper, 2016).

To increase the penetration of physical activity among youth can be addressed by enabling a fund that can be sustained for the Aboriginal and Torres Strait Islander people. Implementation of such a plan can be attributed to the design and conduct of health service and delivering health service (Jesseph, 2018). This can be sustained by the community practice. Infrastructural support program can be provided for the Aboriginal and Torres Strait Islander people for open space and safe participation among countries and qualified for cycling, walking and cycling infrastructure as well as community staff for building the program. Addressing pre-bias among the youth will be the key to addressing the physical activity program within the community. Geographical remoteness and lower socioeconomic pattern represented unawareness towards physical activity attributes (Hilton, 2004). Participation in sports minimizes increase the risk of adverse health and facilitates wellbeing among the Aboriginal community. Shyness and embarrassment as attributes among young adolescents can be removed by cross-cultural programs and reiterating the importance of physical activity among youth (Nelson, 2010).

This will help in a training program for young adults. The individual feeling can be used as a sense of perceived behavior from the community that results due to bodily appearance and physical skill that restrain the physical activity among the young adults. Communication of platform with cultural sensitivity decanting self-performance other than shame will encourage active participation. The importance of understanding the interactions between individual, community, and cultural factors particularly concerning the gender and geographic location of young Aboriginal and Torres is of outmost significance. It is additionally important to design the program for implementation with consistent training, technical support, and creating comfortable space. A well-designed program can facilitate Aboriginal and Torres Islander in a comfortable setting for physical setting as an engaging medium for running the program.

This is a designed program for evaluation of pre-program workshops and supportive aid for women to equip and enroll them in training programs. Cultural adaptations for the inclusion of designing program among minority and diverse group can be developed through a road map for cultural factors and designing of community values and belief in the program (Mulavle et al., 2019). Mobilization of engagement through the assignment of individual in group activity and creating adaptive action has a high potential for increased engagement. Ensuring the health and safety matrix with a gap analysis of the study unit is observed to address physic activity and platform. Physical activities development and implementation require an effective response by a commitment from the non-indigenous population and foster collaboration between local organizations for cultural awareness. 

Cooper (2016) highlights the development of outcomes and mutually beneficial programs to enhance program outcomes and maintenance of information. Parents' management and local organization can aid the success of the strategy for the co-designing program. Indigenous people need to be supported for knowledge and cultural inheritance as strength in physical activity engagement. Physical activity through exercise and strength training can improve social well being among individuals and improve wellness in community members. The inclusion of physic activities in school programs and labeling programs as healthy staff workers will improve the association of health workers and the Indigenous community.

Establishing a support network and annual newsletter for advantages for physical health advantages will promote participates and engagement. Socio-cultural factors impact the individual’s participation as with the indigenous population that has a lower income than their non-indigenous participants and have poor educational attainment (Sushames, 2017). Implementation of physical activity program can face the sense of education and employment option in the community. The cultural interface development can assist indigenous planning experience as promoting active living and developing physical activity as a strength-based approach. Physical activity through teaching aid and an informational development plan for Indigenous youth creates a change in behavior among individuals. Consideration should be given to the maintenance of physical facility and infrastructure. The organization of activity should be done as per climate-specific area and remote area and should have appropriate design of activity and trainer for Aboriginal and Torres Islander. Priority should be given to program viability and the sustainability indicator for the customer-community fit program. Health educators need to approach physical activity engagement with diversity and tailoring requirements on soft skills, physical strength to recognize Indigenous people.

Considering the unique historical context health experiences of Aboriginal and Torres Islander people are important. Sharing information about the program practice as an initiative to reduce inequality will provide optimum program practice will act as community cohesion. Key recommendations that were provided for the co-designing program addressed working in partnership with local organizations and facilitate a positive network for peer group participation. Co-design through capacity building help in the local community and increasing awareness of the health program.

Evaluation of outcome is essential for a structured process and adaptive approach. Inclusiveness as a principle of co-design utilizes feedback and experience to develop solutions. Increasing community member awareness will prepare in contributing for design and development for local decision making improving halt awareness and reporting finding s to stakeholders for reflective practice Ongoing education is important to gain improvement and reduce stigma over time

References for Applying Experience-Based Co-Design with Vulnerable Populations

Brien, J., Fossey, E., Palmer, J (2020). A scoping review of the use of co?design methods with culturally and linguistically diverse communities to improve or adapt mental health services. 1-17. DOI: https://doi.org/10.1111/hsc.13105

Hilton, T.R., Brown, V.J. (2004). Physical activity among Aboriginal and Torres Strait Islander people and communities. 7(1). Journal of Science and Medicine in Sports. DOI: https://doi.org/10.1016/S1440-2440(04)80276-7

Jessup, R., Osborne, R., Buchbinder. R., & Beauchamp, A., (2018). Using co-design to develop interventions to address health literacy needs in a hospitalized population. BMC Health Services Research, 18(1) , 989 DOI: https://doi.org/10.1186/s12913-018-3801-7

Farrington, J. (2016). Co-designing healthcare systems: between transformation and tokenism. Journal of Royal Society of medicine, 109(10), 368-371. DOI: DOI: 10.1177/0141076816658789

Cooper, K., Gillmore, C., & Hogg, L. (2016). Experience-based co-design in an adult psychological therapies service. Journal of Mental Health, 25(1), 36–40.

Mulvale et al. (2019). Co-designing health and other public services with vulnerable and disadvantaged populations: Insights from an international collaboration.. Journal of public participation and healthcare ,22(3). 248-497. DOI: https://doi.org/10.1111/hex.12864

Mulvale, A..Miatello, A., Hackett, C., & Mulvale, G. (2016). Applying experience-based co-design with vulnerable populations: Lessons from a systematic review of methods to involve patients, families, and service providers in child and youth mental health service improvement. Patient experience Journal. 117-129

Nelson, A. (2010). Indigenous Australians and physical activity: using a social-ecological model to review the literature. Health education research,  25(3), 489-509.

Sushames, A., Engelberg, T., Gebel, K. (2017). Perceived barriers and enablers to participation in a community-tailored physical activity program with Indigenous Australians in a regional and rural setting: a qualitative study. International Journal for equity in health, 16(1), DOI: https://doi.org/10.1186/s12939-017-0664-1

Sushames, A., Uffelen, J.G., Gebel, K., (2016). Do physical activity interventions in Indigenous people in Australia and New Zealand improve activity levels and health outcomes? A systematic review. 13(1). International Journal of Behavior Nutrition and Physical activity. DOI: 10.1186/s12966-016-0455-x

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